Provider Demographics
NPI:1467118117
Name:CREISSTOFF, IVANA JILLIAN (PA)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:JILLIAN
Last Name:CREISSTOFF
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 NORTHGATE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9413
Mailing Address - Country:US
Mailing Address - Phone:484-222-4646
Mailing Address - Fax:
Practice Address - Street 1:5325 NORTHGATE DR STE 200
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9413
Practice Address - Country:US
Practice Address - Phone:484-222-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-008207207X00000X
PAMA066354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery