Healthcare Provider Details

I. General information

NPI: 1346246378
Provider Name (Legal Business Name): WINSTON JOSEPH C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DREISER LOOP APT 2B
BRONX NY
10475-2661
US

IV. Provider business mailing address

66 POWERHOUSE RD 3RD FLOOR
ROSLYN HEIGHTS NY
11577-1324
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-1024
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number487175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: