Healthcare Provider Details

I. General information

NPI: 1588951321
Provider Name (Legal Business Name): MOSAES BUCHANAN RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

22417 KINGSBURY AVE # B
OAKLAND GARDENS NY
11364-3626
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-3060
  • Fax:
Mailing address:
  • Phone: 347-554-7789
  • Fax: 718-465-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number575242
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number575242
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number575242
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157824
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number575242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: