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NPI Code Detail

MEDICARE: JOHN SAMUEL POLECHETTI CRNA

MEDICARE: JOHN SAMUEL POLECHETTI CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist3315571NY

General Provider Information

NPI Number : 1457389868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN SAMUEL POLECHETTI CRNA
Provider Business Mailing Address
First Line : 555 PINE ST
Second Line :
City : LOCKPORT
State : NY
Zip : 14094-5547
Country : US
Telephone Number : 716-465-0222
Fax Number :
Provider Business Practice Location Address
First Line : 2200 S HOUGHTON RD
Second Line :
City : TUCSON
State : AZ
Zip : 85748-7632
Country : US
Telephone Number : 520-742-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 12/30/2024

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