Provider Demographics
NPI:1609861533
Name:ENGLERT, CRYSTAL L (PA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 ERIE CANAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4609
Mailing Address - Country:US
Mailing Address - Phone:585-719-9600
Mailing Address - Fax:585-719-9872
Practice Address - Street 1:120 ERIE CANAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4609
Practice Address - Country:US
Practice Address - Phone:585-719-9600
Practice Address - Fax:585-719-9872
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02651412Medicaid
NY9512952OtherIHA
NY000570536004OtherHEALTH NOW
NY16-1225826OtherN. AMERICAN PREFERRED
NY70131000067OtherFIDELIS
NY27187206OtherUNIV ERA
NY16-1225826OtherNOVA
NY199399FZOtherPREFFERED CARE
NY21292163036OtherBEECHSTREET
NY02651412Medicaid
NY02651412Medicaid