Healthcare Provider Details

I. General information

NPI: 1609854801
Provider Name (Legal Business Name): GALINA GUROVA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55 STREET LUTHERAN MEDICAL CENTER DEPT OF ANESTHESIOLOGY
BROOKLYN NY
11220
US

IV. Provider business mailing address

1927 78TH ST APT 2-B
BROOKLYN NY
11214-1248
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7452
  • Fax: 718-630-6399
Mailing address:
  • Phone: 718-375-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4754221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: