Provider Demographics
NPI:1083266001
Name:FARINHA, CRYSTAL JOSEPHINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOSEPHINE
Last Name:FARINHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 LAMOKA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3435
Mailing Address - Country:US
Mailing Address - Phone:917-288-7865
Mailing Address - Fax:
Practice Address - Street 1:2905 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4653
Practice Address - Country:US
Practice Address - Phone:718-351-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
NY023775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant