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NPI Code Detail

MEDICARE: JUSTINE ZOELLER CRNA

MEDICARE: JUSTINE ZOELLER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse618645NY
2367500000XCertified Registered Nurse Anesthetist618645NY

General Provider Information

NPI Number : 1801359021
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE ZOELLER CRNA
Provider Business Mailing Address
First Line : 301 W 53RD ST APT 25C
Second Line :
City : NEW YORK
State : NY
Zip : 10019-5757
Country : US
Telephone Number : 203-731-1505
Fax Number :
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 718-920-4321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2019
Last Update Date : 03/03/2026

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