Fedorwich, Christy L
Fedorwich, Christy L is an individual health care provider with primary practice located at 30 Harrison St Ste 250 , Johnson City NY 13790-2176. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Fedorwich, Christy L can be contacted via phone (607) 763-6580.Contact Information
Primary practice address
30 Harrison St Ste 250
Johnson City NY 13790-2176
Phone: (607) 763-6580
Fax: (607) 763-6782
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 001613 | Connecticut |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | MP00218800 | New Jersey |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 024817 | New York |
Profile Details
| NPI number | 1588643472 |
|---|---|
| LBN Legal business name | Fedorwich, Christy L |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 10th, 2006 |
| Last updated | Dec 30th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588643472 | NPPES |
| Connecticut | Other | 001613 | PHYSICIAN LICENSE |
| Connecticut | MEDICAID | 004236007 | PHYSICIAN LICENSE |
| Connecticut | Other | 1064074 | PHYSICIAN LICENSE |
| Connecticut | Other | 25MP00218800 | PHYSICIAN LICENSE |
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