MEDICARE: LAKEWOOD ANESTHESIA ASSOCIATES 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1619276755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 302
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-0302
Country	:	US
Telephone Number	:	732-264-1127
Fax Number	:	732-264-0670

Provider Business Practice Location Address
First Line	:	1215 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-6958
Country	:	US
Telephone Number	:	732-264-1127
Fax Number	:	732-264-0670

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. WAYNE GROSJEAN
Credential	:	M.D.
Telephone Number	:	732-264-1127

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	06/05/2013

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