Healthcare Provider Details

I. General information

NPI: 1679875587
Provider Name (Legal Business Name): KEITH A. COMBER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

700 ROUTE 130 N SUITE 203
CINNAMINSON NJ
08077-3365
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-2901
  • Fax:
Mailing address:
  • Phone: 856-829-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR11591900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: