MEDICARE: ADVANCED AMBULATORY ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED AMBULATORY ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 343
Second Line	:
City	:	MIDLAND PARK
State	:	NJ
Zip	:	07432-0343
Country	:	US
Telephone Number	:	862-229-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5054
Country	:	US
Telephone Number	:	862-229-0559
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL A REUVENI
Credential	:	M.D.
Telephone Number	:	862-229-0559

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/29/2020

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