MEDICARE: OFFICE ANESTHESIA SOLUTIONS

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	261QP3300X	Pain Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1518575802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OFFICE ANESTHESIA SOLUTIONS

Provider Business Mailing Address
First Line	:	15747 ROSE AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-2327
Country	:	US
Telephone Number	:	917-975-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 N 11TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-1118
Country	:	US
Telephone Number	:	917-975-4326
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHIBRAH JAMIL
Credential	:	MD
Telephone Number	:	917-975-4163

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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Directions to “OFFICE ANESTHESIA SOLUTIONS ” Practice Location

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