Provider Demographics
NPI:1295750362
Name:LONG, CRYSTAL B (PA-C)
Entity type:Individual
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First Name:CRYSTAL
Middle Name:B
Last Name:LONG
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-288-1418
Mailing Address - Fax:814-288-5427
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3443
Practice Address - Country:US
Practice Address - Phone:814-288-1418
Practice Address - Fax:814-288-5427
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMA052464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ65346Medicare UPIN