Healthcare Provider Details

I. General information

NPI: 1295764801
Provider Name (Legal Business Name): JANA P GREENBLATT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR SUITE 160
BETHESDA MD
20187-3292
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 571-233-3292
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024165990
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR168948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: