Provider Demographics
NPI:1295155703
Name:TONEY, DEREK (CRNA)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:TONEY
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 1:514 W 50TH ST
Mailing Address - Street 2:APT 4RE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7005
Mailing Address - Country:US
Mailing Address - Phone:304-685-3746
Mailing Address - Fax:
Practice Address - Street 1:514 W 50TH ST
Practice Address - Street 2:APT 4RE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7005
Practice Address - Country:US
Practice Address - Phone:304-685-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715658367500000X
NC239044367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered