Provider Demographics
NPI:1629383179
Name:RESOURCE CERTIFIED REGISTERED NURSE ANESTHETIST SERVICES, LLC.
Entity Type:Organization
Organization Name:RESOURCE CERTIFIED REGISTERED NURSE ANESTHETIST SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:516-330-3979
Mailing Address - Street 1:84 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1335
Mailing Address - Country:US
Mailing Address - Phone:516-330-3979
Mailing Address - Fax:212-481-6888
Practice Address - Street 1:84 GRANT AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1335
Practice Address - Country:US
Practice Address - Phone:516-330-3979
Practice Address - Fax:212-481-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center