Healthcare Provider Details

I. General information

NPI: 1114924214
Provider Name (Legal Business Name): NICK SCHEWTSCHENKO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL ANESTHESIA DEPARTMENT
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 845-431-5629
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number460895
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: