Healthcare Provider Details

I. General information

NPI: 1750629770
Provider Name (Legal Business Name): JOSEPH MICHAEL CRINITI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST SUITE 30301
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

39 HOMESTEAD DR
STORRS CT
06268-3102
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-9666
  • Fax:
Mailing address:
  • Phone: 860-478-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5286
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: