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NPI Code Detail

MEDICARE: RIVER EAST ANESTHESIA PRACTICE, PC

MEDICARE: RIVER EAST ANESTHESIA PRACTICE, PC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1770530156
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER EAST ANESTHESIA PRACTICE, PC
Provider Business Mailing Address
First Line : 744 W MICHIGAN AVE
Second Line :
City : JACKSON
State : MI
Zip : 49201-1909
Country : US
Telephone Number : 517-787-6440
Fax Number :
Provider Business Practice Location Address
First Line : 1879 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2709
Country : US
Telephone Number : 212-423-4075
Fax Number :
Authorized Official
Title or Position : AUTH REP
Name : THEODORE HANLEY
Credential : MD
Telephone Number : 212-423-4075
Provider Enumeration Date : 05/30/2006
Last Update Date : 06/06/2008

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Directions to “RIVER EAST ANESTHESIA PRACTICE, PC ” Practice Location

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