Healthcare Provider Details

I. General information

NPI: 1780148080
Provider Name (Legal Business Name): VISTA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COMMERCE DR STE 250
CRANFORD NJ
07016-3621
US

IV. Provider business mailing address

PO BOX 4307
UPPER MARLBORO MD
20775-0307
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 Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND SMITH
Title or Position: OWNER
Credential:
Phone: 908-653-9399