MEDICARE: JOSEPH GNOLFO III 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
1	367500000X	Certified Registered Nurse Anesthetist	081117	CT
2	367500000X	Certified Registered Nurse Anesthetist	543496	NY

General Provider Information

NPI Number	:	1770737611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GNOLFO III CRNA

Provider Business Mailing Address
First Line	:	STONY BROOK UNIVERSITY MEDICAL CTR
Second Line	:	HSC LEVEL 4 - ROOM 060
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8480
Country	:	US
Telephone Number	:	631-444-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	STONY BROOK UNIVERSITY MEDICAL CTR
Second Line	:	HSC LEVEL 4 - ROOM 060
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8480
Country	:	US
Telephone Number	:	631-444-2975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	05/01/2026

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