Provider Demographics
NPI:1538189956
Name:MINEO, ROBERT (CRNA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MINEO
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:PO BOX 7025
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930
Mailing Address - Country:US
Mailing Address - Phone:631-329-6925
Mailing Address - Fax:632-329-6951
Practice Address - Street 1:265 HERRICK ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-726-8350
Practice Address - Fax:631-726-8519
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR5A311Medicare UPIN