1831245125 NPI number — MR. BRIAN ROBERT HEALEY RN, CRNA

Table of content: MR. BRIAN ROBERT HEALEY RN, CRNA (NPI 1831245125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831245125 NPI number — MR. BRIAN ROBERT HEALEY RN, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEALEY
Provider First Name:
BRIAN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831245125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WESTCLIFF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE GROVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11755-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-988-1837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
ROCKY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11778-8556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-744-3671
Provider Business Practice Location Address Fax Number:
631-744-6205
Provider Enumeration Date:
01/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  534740 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 077430 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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