Individual provider Active NPI

Corazon C Gatchalian, CRNA

  • Certified Registered Nurse Anesthetist
  • Staten Island, NY
National Provider Identifier
1649278268
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
324212-1 Issued in NY
Practice address
417 Lisk Ave
Staten Island, NY 10303-1779
Phone
(718) 877-4631
NPI assigned
Jul 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 324212-1 NY Primary

Addresses

Primary practice location

417 Lisk Ave
Staten Island, NY 10303-1779

Mailing address

417 Lisk Ave
Staten Island, NY 10303-1779
Phone (718) 877-4631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040826000090 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688648462 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
324212NYMDPsychiatry Physician
324212-1NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Associates of Boro Park, LLP Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2013 Accepting new patients
Wine Anesthesia, LLC CurrentSince Jun 1, 2015 Accepting new patients
Si Bayview Medical Group, PC Past Accepting new patients
Maimonides Department of Psychiatry FPP Past Accepting new patients
Summit Anesthesia Associates PA Past Accepting new patients
American Anesthesia Business Partners, LLP PastSince Oct 21, 2025 Accepting new patients

Locations

4802 10th Ave
#C
Brooklyn, NY 11219
Phone (718) 283-8163

931 48th St
Brooklyn, NY 11219
Phone (718) 283-8092

966 50th St
Brooklyn, NY 11219
Phone (718) 435-1777

129 Slosson Ave
Staten Island, NY 10314
Phone (718) 720-5928

475 Seaview Ave
Staten Island, NY 10305
Phone (718) 226-8855

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1649278268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 LISK AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031779",
            "telephone_number": "718-877-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 LISK AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031779",
            "telephone_number": "718-877-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATCHALIAN",
        "first_name": "CORAZON",
        "middle_name": "C",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-08",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "324212-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.