Healthcare Provider Details

I. General information

NPI: 1467437566
Provider Name (Legal Business Name): LYNN CRUMMY DT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E MAIN ST UNITED MEDICAL ASSOCIATES PC
ENDICOTT NY
13760-5428
US

IV. Provider business mailing address

346 GRAND AVE UNITED MEDICAL ASSOCIATES PC
JOHNSON CITY NY
13790-2558
US

V. Phone/Fax

Practice location:
  • Phone: 607-757-2600
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0665401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: