Healthcare Provider Details

I. General information

NPI: 1851492045
Provider Name (Legal Business Name): CLAUDIA F KRIDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA LYNDAKER

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVENUE
CENTRAL SQUARE NY
13036
US

IV. Provider business mailing address

800 CARTER ST ATTN CREDENTIALING
ROCHESTER NY
14621-2604
US

V. Phone/Fax

Practice location:
  • Phone: 315-676-2935
  • Fax: 315-668-3873
Mailing address:
  • Phone: 585-336-4858
  • Fax: 585-336-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: