Provider Demographics
NPI:1336275155
Name:SANFILIPPO, MARLENE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PERILLO CT
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1600
Mailing Address - Country:US
Mailing Address - Phone:845-735-7029
Mailing Address - Fax:
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:SUITE 105
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-357-5770
Practice Address - Fax:845-357-8263
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266573367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR4A811Medicare ID - Type Unspecified