Basic Information
| Provider Information | |||||||||
| NPI: | 1609861533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLERT | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLER | ||||||||
| OtherFirstName: | CRYSTAL | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | DEPT. 441 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 WEILAND RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146263919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857199600 | ||||||||
| FaxNumber: | 5857199872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 010510 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000570536004 | 01 | NY | HEALTH NOW | OTHER | 199399FZ | 01 | NY | PREFFERED CARE | OTHER | 21292163036 | 01 | NY | BEECHSTREET | OTHER | 9512952 | 01 | NY | IHA | OTHER | 16-1225826 | 01 | NY | N. AMERICAN PREFERRED | OTHER | 27187206 | 01 | NY | UNIV ERA | OTHER | 16-1225826 | 01 | NY | NOVA | OTHER | 70131000067 | 01 | NY | FIDELIS | OTHER | 02651412 | 05 | NY | MEDICAID |