Healthcare Provider Details

I. General information

NPI: 1922246248
Provider Name (Legal Business Name): JEAN M LEFEVRE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

POB 141277
STATEN ISLAND NY
10314-1277
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1080
  • Fax:
Mailing address:
  • Phone: 718-815-1000
  • Fax: 718-815-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5780873
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number524329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: