Healthcare Provider Details

I. General information

NPI: 1841772225
Provider Name (Legal Business Name): NICHOLAS BARONE DNP, CRNA/APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

182 TENNYSON DR
STATEN ISLAND NY
10308-3358
US

V. Phone/Fax

Practice location:
  • Phone: 718-644-1128
  • Fax:
Mailing address:
  • Phone: 718-644-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number618454
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00929900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: