Provider Demographics
NPI:1427782168
Name:CROWNED ROYALTY LLC
Entity type:Organization
Organization Name:CROWNED ROYALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELFON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:516-504-5586
Mailing Address - Street 1:1445 WOODMONT LN NW STE 4613
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:404-919-4552
Mailing Address - Fax:
Practice Address - Street 1:1445 WOODMONT LN NW STE 4613
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2866
Practice Address - Country:US
Practice Address - Phone:404-919-4552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier