Healthcare Provider Details

I. General information

NPI: 1073747846
Provider Name (Legal Business Name): MOIRA FRANCES CANTY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-4191
  • Fax:
Mailing address:
  • Phone: 516-945-3185
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number075185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: