Basic Information
| Provider Information | |||||||||
| NPI: | 1831245125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEALEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WESTCLIFF LN | ||||||||
| Address2: | |||||||||
| City: | LAKE GROVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117552009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319881837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 ROUTE 25A | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | ROCKY POINT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117788556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317443671 | ||||||||
| FaxNumber: | 6317446205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2007 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 534740 | NY | N | Nursing Service Providers | Registered Nurse | 367500000X | 077430 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.