Individual
CRYSTAL L ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-3494
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-3494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022847
NY
Other
Enumeration date
10/17/2018
Last updated
02/28/2019
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