Provider Demographics
NPI:1750594727
Name:EZMAN, CRYSTAL LYNN (LMT, GN)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:EZMAN
Suffix:
Gender:F
Credentials:LMT, GN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 FOX CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5419
Mailing Address - Country:US
Mailing Address - Phone:585-764-8995
Mailing Address - Fax:
Practice Address - Street 1:1687 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1609
Practice Address - Country:US
Practice Address - Phone:585-764-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist