Healthcare Provider Details

I. General information

NPI: 1205881117
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF NEW LONDON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVE
NEW LONDON CT
06320-4700
US

IV. Provider business mailing address

PO BOX 744533
ATLANTA GA
30374-4533
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0711
  • Fax: 860-443-4458
Mailing address:
  • Phone: 973-251-1132
  • Fax: 913-242-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GILBERT L. DROZDOW
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 973-251-1132