Provider Demographics
NPI:1285731273
Name:CRISTAL, ROBERT M (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:CRISTAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SHELTER LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2524
Mailing Address - Country:US
Mailing Address - Phone:516-621-3339
Mailing Address - Fax:516-626-0457
Practice Address - Street 1:37 SHELTER LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2524
Practice Address - Country:US
Practice Address - Phone:516-621-3339
Practice Address - Fax:516-626-0457
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005576-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV14881Medicare ID - Type UnspecifiedPSYCHOLOGIST