Provider Demographics
NPI:1346246378
Name:JOSEPH, WINSTON (CRNA)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 POWERHOUSE RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1324
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:
Practice Address - Street 1:100 DREISER LOOP APT 2B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2661
Practice Address - Country:US
Practice Address - Phone:718-671-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487175367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR5C241Medicare ID - Type Unspecified
NYP66779Medicare UPIN
NY0422ACMedicare ID - Type Unspecified