Provider Demographics
NPI:1639655475
Name:PIAZZOLA, JULIAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
Last Name:PIAZZOLA
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 1:5843 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3246
Mailing Address - Country:US
Mailing Address - Phone:917-402-2756
Mailing Address - Fax:
Practice Address - Street 1:5843 59TH ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3246
Practice Address - Country:US
Practice Address - Phone:917-402-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-09-24
Deactivation Date:2018-08-31
Deactivation Code:
Reactivation Date:2018-09-19
Provider Licenses
StateLicense IDTaxonomies
NY123667367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered