Healthcare Provider Details

I. General information

NPI: 1700567807
Provider Name (Legal Business Name): ANDRE ZUMERCHIK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 RIDGE RD
NORTH HAVEN CT
06473-2023
US

IV. Provider business mailing address

1868 RIDGE RD
NORTH HAVEN CT
06473-2023
US

V. Phone/Fax

Practice location:
  • Phone: 347-536-9295
  • Fax:
Mailing address:
  • Phone: 347-536-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9601945
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11040364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: