Provider Demographics
NPI:1467437566
Name:CRUMMY, LYNN (DT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CRUMMY
Suffix:
Gender:M
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5428
Practice Address - Country:US
Practice Address - Phone:607-757-2600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06654012081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01096946Medicaid
NYDD3228Medicare ID - Type Unspecified
NY01096946Medicaid