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General NPI Number Information
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NPI Number | 1689685232
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Entity Type | Individual
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Provider Name | ROBERT MIRYNOWSKI CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/29/2025
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Provider Practice Location Address
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Address Line | 901 W MAIN ST BLDG B
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-303-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 882 ELTON ADELPHIA RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-8616
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Country | US
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Telephone | 732-740-2357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26N007829700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ00183300
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License Number State | NJ
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