Healthcare Provider Details

I. General information

NPI: 1265949028
Provider Name (Legal Business Name): MONIKA M KAPUSNIAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

PO BOX 550 2 CATHARINE STREET, MID-HUDSON ANETHESIOLOGISTS, PC
POUGHKEEPSIE NY
12602
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax:
Mailing address:
  • Phone: 866-885-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number642893-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: