Healthcare Provider Details

I. General information

NPI: 1871524033
Provider Name (Legal Business Name): JERSEY ELITE ANESTHESIA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 PALISADE AVE
JERSEY CITY NJ
07306-1121
US

IV. Provider business mailing address

PO BOX 51045
NEWARK NJ
07101-5145
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-2481
  • Fax: 201-943-8105
Mailing address:
  • Phone: 201-945-2481
  • Fax: 201-943-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DUEN S SHIH
Title or Position: PRESIDENT
Credential: MD
Phone: 201-945-2481