Healthcare Provider Details

I. General information

NPI: 1821631003
Provider Name (Legal Business Name): VINH TRAM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

1053 TIMOTHY LN
NISKAYUNA NY
12309-1617
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4800
  • Fax:
Mailing address:
  • Phone: 646-675-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648534
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number648534
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number129283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: