Basic Information
| Provider Information | |||||||||
| NPI: | 1710532692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAGLE | ||||||||
| FirstName: | ALYSON | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE BOX 665 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755321 | ||||||||
| FaxNumber: | 5852761202 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 LAC DE VILLE BLVD BLDG D | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146185647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755321 | ||||||||
| FaxNumber: | 5852761202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2019 | ||||||||
| LastUpdateDate: | 09/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 023997 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 363AS0400X | 023997 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 207XX0004X | 023997 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.