Healthcare Provider Details

I. General information

NPI: 1184722373
Provider Name (Legal Business Name): ANESTHESIA HEALTHCARE PARTNERS OF CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVENUE STE 380
HAMDEN CT
06518-3602
US

IV. Provider business mailing address

DEPT 40112 PO BOX 740209
ATLANTA GA
30374-0209
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN L. VAN SPRUNDEL
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 941-360-1566