Healthcare Provider Details

I. General information

NPI: 1922198738
Provider Name (Legal Business Name): ROBERT S JURASINSKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTENNIAL BLVD SUITE 3
VOORHEES NJ
08043-4689
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6505
  • Fax: 856-325-6515
Mailing address:
  • Phone: 856-963-6888
  • Fax: 856-968-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNR63015
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: