Healthcare Provider Details

I. General information

NPI: 1487656831
Provider Name (Legal Business Name): ANTHONY PUNZO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CONTINENTAL DR SUITE 412
NEWARK DE
19713-4306
US

IV. Provider business mailing address

111 CONTINENTAL DR SUITE 412
NEWARK DE
19713-4306
US

V. Phone/Fax

Practice location:
  • Phone: 302-709-4497
  • Fax: 302-733-0854
Mailing address:
  • Phone: 302-709-4497
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-232224-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25NR08396100
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: