Healthcare Provider Details

I. General information

NPI: 1851563043
Provider Name (Legal Business Name): CHRISTOPHER O'NEILL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRONT ST
ELMER NJ
08318-2101
US

IV. Provider business mailing address

PO BOX 8500-4066
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8000
  • Fax:
Mailing address:
  • Phone: 302-733-0806
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NO11082000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: