Healthcare Provider Details

I. General information

NPI: 1639177819
Provider Name (Legal Business Name): EMILY BAGLIONE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 WESTERN AVE STE 102 ANESTHESIA GROUP OF ALBANY, PC
ALBANY NY
12203-3539
US

IV. Provider business mailing address

1450 WESTERN AVE STE 102 ANESTHESIA GROUP OF ALBANY, PC
ALBANY NY
12203-3539
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-0050
  • Fax: 518-207-2973
Mailing address:
  • Phone: 518-463-0050
  • Fax: 518-207-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number423217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: