Provider Demographics
NPI:1891809125
Name:KOEHLER, PATRICK JOSEPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 FAIR OAKS PL
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1807
Mailing Address - Country:US
Mailing Address - Phone:516-528-9582
Mailing Address - Fax:516-536-4495
Practice Address - Street 1:232 FAIR OAKS PL
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1807
Practice Address - Country:US
Practice Address - Phone:516-528-9582
Practice Address - Fax:516-536-4495
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3092481367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR1A591Medicare ID - Type Unspecified