Healthcare Provider Details

I. General information

NPI: 1518963289
Provider Name (Legal Business Name): STACY COOK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/19/2009
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 TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number454232-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: