Healthcare Provider Details

I. General information

NPI: 1851625362
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF NEW HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 NEW HAVEN AVE UNIT 6I
DERBY CT
06418-2141
US

IV. Provider business mailing address

204 NEW HAVEN AVE UNIT 6I
DERBY CT
06418-2141
US

V. Phone/Fax

Practice location:
  • Phone: 914-830-3985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number066951
License Number StateCT

VIII. Authorized Official

Name: LUIS RENE OROZCO
Title or Position: CRNA
Credential:
Phone: 914-830-3985