Provider Demographics
NPI:1871387803
Name:CROWN 13 INC
Entity type:Organization
Organization Name:CROWN 13 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAEKAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELYASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-660-6344
Mailing Address - Street 1:37 BELLINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 BELLINGHAM LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1322
Practice Address - Country:US
Practice Address - Phone:516-660-6344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center