Healthcare Provider Details

I. General information

NPI: 1407279094
Provider Name (Legal Business Name): ARLENE DIANA RICCIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARLENE DIANA WITKOWSKI CRNA

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 LAFAYETTE AVE STE 204
SUFFERN NY
10901-5620
US

IV. Provider business mailing address

233 LAFAYETTE AVE STE 204
SUFFERN NY
10901-5620
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-5775
  • Fax: 845-357-5777
Mailing address:
  • Phone: 845-357-5775
  • Fax: 845-357-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00489800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number641467-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: