Provider Demographics
NPI:1386644748
Name:MIGLIACCIO, ALLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MIGLIACCIO
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 1:536 S JAY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-1626
Mailing Address - Country:US
Mailing Address - Phone:315-336-3933
Mailing Address - Fax:
Practice Address - Street 1:536 S JAY ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-1626
Practice Address - Country:US
Practice Address - Phone:315-336-3933
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 557367500000X
NY259891-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0970Medicaid
Q32534Medicare UPIN