Healthcare Provider Details

I. General information

NPI: 1891955175
Provider Name (Legal Business Name): WALTER SCHIFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF ANESTHESIOLOGY HSC L4 060
STONY BROOK NY
11794-8480
US

IV. Provider business mailing address

STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF ANESTHESIOLOGY HSC L4060
STONY BROOK NY
11794-8480
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax: 631-444-2907
Mailing address:
  • Phone: 631-444-2975
  • Fax: 631-444-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number363121 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: