Healthcare Provider Details

I. General information

NPI: 1639087828
Provider Name (Legal Business Name): PARIS JERMEL CRANE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SENECA AVE
ROCHESTER NY
14621-2326
US

IV. Provider business mailing address

182 SENECA AVE
ROCHESTER NY
14621-2326
US

V. Phone/Fax

Practice location:
  • Phone: 585-362-9123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number354571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: