Healthcare Provider Details

I. General information

NPI: 1003254830
Provider Name (Legal Business Name): SARAH BETH KORNHABER C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH BETH KUSZEK

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR DEPT OF ANESTHESIA
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4887
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number667965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: