Healthcare Provider Details

I. General information

NPI: 1376022954
Provider Name (Legal Business Name): HAWTHORN ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LINCOLN AVE
HAWTHORNE NJ
07506-1436
US

IV. Provider business mailing address

110 ROCHELLE AVE
ROCHELLE PARK NJ
07662-4329
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1205
  • Fax:
Mailing address:
  • Phone: 201-693-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB7591000
License Number StateNJ

VIII. Authorized Official

Name: TIMOTHY FINLEY
Title or Position: PRESIDENT
Credential: DO
Phone: 201-693-6953