Healthcare Provider Details

I. General information

NPI: 1538276126
Provider Name (Legal Business Name): SNYH CORNELL CRNA ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10021-4870
US

IV. Provider business mailing address

525 E 68TH ST
NEW YORK NY
10021-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2846
  • Fax: 212-746-8108
Mailing address:
  • Phone: 212-746-2846
  • Fax: 212-746-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER KELLS
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 212-590-5741