Provider Demographics
NPI:1811963309
Name:DECKOFF, LEE J (CRNA)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:J
Last Name:DECKOFF
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 1:75 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6290
Mailing Address - Country:US
Mailing Address - Phone:302-698-9472
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:BAYHEALTH MEDICAL CENTER, DEPT. OF ANESTHESIA
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL60A00075367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DES65348Medicare UPIN
DE009685K95Medicare PIN