Healthcare Provider Details

I. General information

NPI: 1972739464
Provider Name (Legal Business Name): NORTH BRUNSWICK ANESTHESIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RIMWOOD DR
LINCROFT NJ
07738-1832
US

IV. Provider business mailing address

20 RIMWOOD DR
LINCROFT NJ
07738-1832
US

V. Phone/Fax

Practice location:
  • Phone: 732-861-0563
  • Fax:
Mailing address:
  • Phone: 732-861-0563
  • 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: ANDREW CITRON
Title or Position: CEO
Credential: MD
Phone: 908-653-9399