Healthcare Provider Details

I. General information

NPI: 1639655475
Provider Name (Legal Business Name): JULIAN PIAZZOLA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date: 08/31/2018
Reactivation Date: 09/19/2018

III. Provider practice location address

5843 59TH ST
MASPETH NY
11378-3246
US

IV. Provider business mailing address

5843 59TH ST
MASPETH NY
11378-3246
US

V. Phone/Fax

Practice location:
  • Phone: 917-402-2756
  • Fax:
Mailing address:
  • Phone: 917-402-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number123667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: