Healthcare Provider Details

I. General information

NPI: 1689690604
Provider Name (Legal Business Name): ROSE B PERRIER-TONICO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WASHINGTON AVE
OCEANSIDE NY
11572-1533
US

IV. Provider business mailing address

2446 WASHINGTON AVE
OCEANSIDE NY
11572-1533
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-0946
  • Fax: 516-536-4495
Mailing address:
  • Phone: 516-536-0946
  • Fax: 516-536-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4170131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: