Healthcare Provider Details

I. General information

NPI: 1174810980
Provider Name (Legal Business Name): ELIZABETH TENEYCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE ANESTHESIA DEPT
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

5000 BRITTONFIELD PKWY PO BOX 2000
EAST SYRACUSE NY
13057-9226
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7828
  • Fax: 315-470-5811
Mailing address:
  • Phone: 315-362-5129
  • Fax: 315-362-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number563718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: