Provider Demographics
NPI:1811056179
Name:POMYGALSKI, SCOTT (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:POMYGALSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:POMYLGASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 N. HARRISON PARKWAY
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2864
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1758
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-871-6073
Practice Address - Fax:201-871-0619
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11682300367500000X
NY549943367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered