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NPI Code Detail

MEDICARE: KRYSTAL MCSPIRIT

MEDICARE: KRYSTAL MCSPIRIT
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1649114851
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL MCSPIRIT
Provider Business Mailing Address
First Line : 2714 STATE HIGHWAY 29
Second Line :
City : JOHNSTOWN
State : NY
Zip : 12095-4041
Country : US
Telephone Number : 518-736-5720
Fax Number : 518-762-1382
Provider Business Practice Location Address
First Line : 2714 STATE HIGHWAY 29
Second Line :
City : JOHNSTOWN
State : NY
Zip : 12095-4041
Country : US
Telephone Number : 518-736-5720
Fax Number : 518-762-1382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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Directions to “ KRYSTAL MCSPIRIT ” Practice Location

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