Basic Information
| Provider Information | |||||||||
| NPI: | 1891118709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTY YU | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 LAFAYETTE AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109015620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453575775 | ||||||||
| FaxNumber: | 8453575777 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 LAFAYETTE AVE | ||||||||
| Address2: | |||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109014812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453685039 | ||||||||
| FaxNumber: | 8453685327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2014 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 58294-1 | NY | N | Nursing Service Providers | Registered Nurse | 367500000X | 582941 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.