Healthcare Provider Details

I. General information

NPI: 1770641367
Provider Name (Legal Business Name): KEVIN EDWARD HINPHY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 WEST JERICHO TURNPIKE
SMITHTOWN NY
11787
US

IV. Provider business mailing address

989 WEST JERICHO TURNPIKE
SMITHTOWN NY
11787
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-7100
  • Fax: 631-864-7129
Mailing address:
  • Phone: 631-864-7100
  • Fax: 631-864-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number474728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: