Basic Information
Provider Information | |||||||||
NPI: | 1205919636 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRAWLEY | ||||||||
FirstName: | ANITA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1001 MAIN ST FL 5 | ||||||||
Address2: |   | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142031009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7163230080 | ||||||||
FaxNumber: | 7163230295 | ||||||||
Practice Location | |||||||||
Address1: | 1001 MAIN ST FL 4 | ||||||||
Address2: |   | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142031009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7163230080 | ||||||||
FaxNumber: | 7163230295 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/21/2006 | ||||||||
LastUpdateDate: | 01/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 406983 | NY | N |   | Nursing Service Providers | Registered Nurse |   | 2080P0206X | F380702 | NY | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 363LP0200X | F380702 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
ID | Type | State | Issuer | Description | 000560684001 | 01 | NY | BC/BS | OTHER | 00027166101 | 01 | NY | UNIVERA | OTHER | 02244484 | 05 | NY |   | MEDICAID | 0018168500001 | 01 |   | PA MEDICAID | OTHER | 5111042 | 01 | NY | IHA | OTHER | 040426002817 | 01 | NY | FIDELIS | OTHER |