Provider Demographics
NPI:1770641367
Name:HINPHY, KEVIN EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
Last Name:HINPHY
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 1:989 WEST JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-864-7100
Mailing Address - Fax:631-864-7129
Practice Address - Street 1:989 WEST JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-864-7100
Practice Address - Fax:631-864-7129
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474728367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00299374OtherMEDICARE RR
P00299374OtherMEDICARE RR
R1B861Medicare ID - Type Unspecified