Healthcare Provider Details

I. General information

NPI: 1053396408
Provider Name (Legal Business Name): MARINA HANUKOFF CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH STREET NY METHODIST HOSPITAL
BROOKLYN NY
11215
US

IV. Provider business mailing address

P.O. BOX 550 2 CATHARINE STREET PARK SLOPE ANESTHESIA ASSOCIATES, PC
POUGHKEEPSIE NY
12602
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3279
  • Fax:
Mailing address:
  • Phone: 866-868-8416
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number493456
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number493456-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: