Healthcare Provider Details

I. General information

NPI: 1104128222
Provider Name (Legal Business Name): DARREN JOHN REGANATO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE FL 3
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

6 BENJAMIN W
MARLTON NJ
08053-7234
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6260
  • Fax:
Mailing address:
  • Phone: 856-719-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00308400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: