Healthcare Provider Details

I. General information

NPI: 1851383400
Provider Name (Legal Business Name): ELAINE HYATT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST STE. 853W, DEPT. OF ANESTHESIOLOGY
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 27578
NEW YORK NY
10087-7578
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1036
  • Fax:
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number464980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: