Provider Demographics
NPI:1851492045
Name:KRIDER, CLAUDIA F (PA)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:F
Last Name:KRIDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:
Other - Last Name:LYNDAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2604
Mailing Address - Country:US
Mailing Address - Phone:585-336-4858
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:3045 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-676-2935
Practice Address - Fax:315-668-3873
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY00355266Medicaid
NYDD1848Medicare ID - Type Unspecified