Individual
PAVEL SIUTSOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
135 STANIE GLEN RD, WATCHUNG, NJ 07069-6235
(862) 754-6151
Mailing address
135 STANIE GLEN RD, WATCHUNG, NJ 07069-6235
(862) 754-6151
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR15434100
NJ
163W00000X
Registered Nurse
793635-01
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ14852700
NJ
367500000X
Certified Registered Nurse Anesthetist
793635
NY
Other
Enumeration date
04/17/2023
Last updated
07/26/2023
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