Healthcare Provider Details

I. General information

NPI: 1962587618
Provider Name (Legal Business Name): SCOTT A DESIMONE C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

PO BOX 307
NEPTUNE NJ
07754-0307
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-0200
  • Fax: 732-897-0263
Mailing address:
  • Phone: 732-897-0200
  • Fax: 732-897-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNO100183
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: