Healthcare Provider Details

I. General information

NPI: 1639435126
Provider Name (Legal Business Name): ELVIN DANIEL AGUILAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ANESTHESIOLOGY STONY BROOK UNIVERSITY HOSPITAL
STONY BROOK NY
11794-8081
US

IV. Provider business mailing address

PO BOX 2174
SAINT JAMES NY
11780-0606
US

V. Phone/Fax

Practice location:
  • Phone: 631-708-6140
  • Fax:
Mailing address:
  • Phone: 407-927-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number638816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: