Healthcare Provider Details

I. General information

NPI: 1184135865
Provider Name (Legal Business Name): BENJAMIN PETER KAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

96 LIVINGSTON ST
BUFFALO NY
14213-1653
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax: 716-632-7842
Mailing address:
  • Phone: 801-688-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number679164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: