Healthcare Provider Details

I. General information

NPI: 1013586312
Provider Name (Legal Business Name): STEPHANIE JOSEPH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

22 IBM RD. SUITE 210 PARK SLOPE ANESTHESIA, PC
POUGHKEEPSIE NY
12601
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone: 866-868-8416
  • Fax: 845-790-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number702659
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number702659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: