Provider Demographics
NPI:1194080663
Name:ASSIFUAH, STEVEN (CRNA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:ASSIFUAH
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 1:172 SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5313
Mailing Address - Country:US
Mailing Address - Phone:516-469-8036
Mailing Address - Fax:
Practice Address - Street 1:172 SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5313
Practice Address - Country:US
Practice Address - Phone:516-469-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4921731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered