MEDICARE: MRS. CRYSTAL L ENGLERT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010510	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9512952	OTHER	NY	IHA
3	000570536004	OTHER	NY	HEALTH NOW
4	16-1225826	OTHER	NY	N. AMERICAN PREFERRED
5	70131000067	OTHER	NY	FIDELIS
6	27187206	OTHER	NY	UNIV ERA
7	16-1225826	OTHER	NY	NOVA
8	199399FZ	OTHER	NY	PREFFERED CARE
9	21292163036	OTHER	NY	BEECHSTREET

General Provider Information

NPI Number	:	1609861533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL L ENGLERT PA

Provider Business Mailing Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:	585-719-9872

Provider Business Practice Location Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:	585-719-9872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/18/2023

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