Provider Demographics
NPI: | 1356325492 |
---|---|
Name: | ALBANO, JOEL (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOEL |
Middle Name: | |
Last Name: | ALBANO |
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: | 150 S WARNER RD |
Mailing Address - Street 2: | SUITE 160 |
Mailing Address - City: | KING OF PRUSSIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19406-2826 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-254-9500 |
Mailing Address - Fax: | 610-254-9501 |
Practice Address - Street 1: | 150 S WARNER RD |
Practice Address - Street 2: | SUITE 160 |
Practice Address - City: | KING OF PRUSSIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19406-2826 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-254-9500 |
Practice Address - Fax: | 610-254-9501 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-12-02 |
Last Update Date: | 2019-02-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | RN344536L | 367500000X |
NJ | 26NJ00260400 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 101239021-0001 | Medicaid | |
NJ | 034042 | Medicare ID - Type Unspecified | |
PA | 101239021-0001 | Medicaid |