Provider Demographics
NPI:1972609709
Name:BATEMAN, CRYSTAL (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 BUFFALO RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1024
Mailing Address - Country:US
Mailing Address - Phone:585-594-9254
Mailing Address - Fax:585-594-9233
Practice Address - Street 1:4415 BUFFALO RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1024
Practice Address - Country:US
Practice Address - Phone:585-594-9254
Practice Address - Fax:585-594-9233
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381346363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP0729OtherPREFERRED CARE