Healthcare Provider Details

I. General information

NPI: 1952855504
Provider Name (Legal Business Name): KELLY CRIMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 DELANCEY ST
NEW YORK NY
10002-3325
US

IV. Provider business mailing address

1345 RXR PLZ
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 212-609-2541
  • Fax:
Mailing address:
  • Phone: 516-453-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019803-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: