Provider Demographics
NPI:1528492816
Name:SANDMAN CERTIFIED REGISTERED NURSE ANESTHETIST, P.C.
Entity type:Organization
Organization Name:SANDMAN CERTIFIED REGISTERED NURSE ANESTHETIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:631-281-3219
Mailing Address - Street 1:41 PROBST DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3318
Mailing Address - Country:US
Mailing Address - Phone:631-281-3219
Mailing Address - Fax:631-395-9416
Practice Address - Street 1:1193 BEACH 9TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4847
Practice Address - Country:US
Practice Address - Phone:718-471-8363
Practice Address - Fax:718-471-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252639-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty