Provider Demographics
NPI:1720134612
Name:TROAST, RICHARD JAY (CRNA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAY
Last Name:TROAST
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 1:468 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2775
Mailing Address - Country:US
Mailing Address - Phone:973-423-2179
Mailing Address - Fax:
Practice Address - Street 1:468 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2775
Practice Address - Country:US
Practice Address - Phone:973-423-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO05095100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ007408Medicare ID - Type Unspecified