Provider Demographics
NPI:1992996110
Name:CRYSTAL, SARA C (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:C
Other - Last Name:TARSHISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 E 76TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2700
Mailing Address - Country:US
Mailing Address - Phone:212-794-3550
Mailing Address - Fax:212-794-0591
Practice Address - Street 1:30 E 76TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2700
Practice Address - Country:US
Practice Address - Phone:212-794-3550
Practice Address - Fax:212-794-0591
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2446292084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program