Provider Demographics
NPI:1831245125
Name:HEALEY, BRIAN ROBERT (RN, CRNA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ROBERT
Last Name:HEALEY
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 WESTCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2009
Mailing Address - Country:US
Mailing Address - Phone:631-988-1837
Mailing Address - Fax:
Practice Address - Street 1:333 ROUTE 25A
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8556
Practice Address - Country:US
Practice Address - Phone:631-744-3671
Practice Address - Fax:631-744-6205
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY534740163W00000X
NY077430367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse