Individual
MS. CHRISTY L FEDORWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
252 S 4TH ST, LEBANON, PA 17042-6111
(717) 270-3751
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 770-0025
(607) 729-3986
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001613
CT
363A00000X
Physician Assistant
Primary
024817
NY
363A00000X
Physician Assistant
MP00218800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001613
PHYSICIAN LICENSE
CT
05
—
004236007
—
CT
01
—
1064074
NCCPA LICENSE
CT
01
—
25MP00218800
STATE
NJ
Enumeration date
01/10/2006
Last updated
08/23/2024
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