Healthcare Provider Details

I. General information

NPI: 1659845253
Provider Name (Legal Business Name): CHRISTIAN WAGA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33
NEPTUNE NJ
07753-0883
US

IV. Provider business mailing address

12 SEMEL AVE
ISELIN NJ
08830-1334
US

V. Phone/Fax

Practice location:
  • Phone: 732-763-4147
  • Fax:
Mailing address:
  • Phone: 732-763-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00892600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: