Provider Demographics
NPI:1023379062
Name:CRYSDI MEDICAL LLC
Entity type:Organization
Organization Name:CRYSDI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-610-1504
Mailing Address - Street 1:6 CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03844-2135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON FALLS
Practice Address - State:NH
Practice Address - Zip Code:03844-2135
Practice Address - Country:US
Practice Address - Phone:617-610-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies