Basic Information
| Provider Information | |||||||||
| NPI: | 1285635797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'LOUGHLIN | ||||||||
| FirstName: | EDWARD | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 KENSICO DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105491009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146668866 | ||||||||
| FaxNumber: | 9146666777 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 STONELEIGH AVE | ||||||||
| Address2: | PUTNAM HOSPITAL | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105123997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452795711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 260074 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.