Basic Information
| Provider Information | |||||||||
| NPI: | 1588175210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DMITRY OSTRO, CRNA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 BRETTON RD | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061191209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464318273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2017 | ||||||||
| LastUpdateDate: | 10/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | OSTRO | ||||||||
| AuthorizedOfficialFirstName: | DMITRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE ANESTHETIST | ||||||||
| AuthorizedOfficialTelephone: | 6464318273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 6029 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.