Healthcare Provider Details

I. General information

NPI: 1225169964
Provider Name (Legal Business Name): MARCO PEREZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE
TROY NY
12180-2475
US

IV. Provider business mailing address

600 FRANKLIN AVE UNIT 7771
GARDEN CITY NY
11530-6844
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-8600
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number499979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: