Healthcare Provider Details

I. General information

NPI: 1336492339
Provider Name (Legal Business Name): JERRY SARFO-DARKO JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CORLISS AVE SUITE 107
JOHNSON CITY NY
13790-2060
US

IV. Provider business mailing address

156 CORLISS AVE SUITE 107
JOHNSON CITY NY
13790-2060
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6735
  • Fax: 607-763-6736
Mailing address:
  • Phone: 607-763-6735
  • Fax: 607-763-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2293069
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081499-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00531600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: