MEDICARE: SYNERGY ANESTHESIA ASSOCIATES, INC.

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	261QM2500X	Medical Specialty Clinic/Center	26NO08575500	NJ

General Provider Information

NPI Number	:	1093182495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY ANESTHESIA ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	133 GAITHER DR STE K
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1710
Country	:	US
Telephone Number	:	856-451-3552
Fax Number	:	856-358-8053

Provider Business Practice Location Address
First Line	:	133 GAITHER DR STE K
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1710
Country	:	US
Telephone Number	:	856-451-3552
Fax Number	:	856-358-8053

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT WILLIAM MCDOUALL
Credential	:	CRNA, MS
Telephone Number	:	856-451-3552

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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