Healthcare Provider Details

I. General information

NPI: 1982927349
Provider Name (Legal Business Name): COURT HOUSE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 DORY DR
CAPE MAY COURT HOUSE NJ
08210-2057
US

IV. Provider business mailing address

36 DORY DR
CAPE MAY COURT HOUSE NJ
08210-2057
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTONIOS THALASSINOS
Title or Position: DIRECTOR
Credential: MD
Phone: 908-653-9399