Provider Demographics
NPI:1437148418
Name:CRILLEY, JASON D (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:CRILLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 23RD ST STE 302A
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2858
Mailing Address - Country:US
Mailing Address - Phone:814-835-3751
Mailing Address - Fax:814-835-3755
Practice Address - Street 1:145 W 23RD ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-835-3751
Practice Address - Fax:814-835-3755
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005554213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88921Medicare UPIN
PA055150Medicare PIN