Healthcare Provider Details

I. General information

NPI: 1235430729
Provider Name (Legal Business Name): GLOBAL ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 ROUTE 539
LITTLE EGG HARBOR TWP NJ
08087-4203
US

IV. Provider business mailing address

PO BOX 441
ORADELL NJ
07649-0441
US

V. Phone/Fax

Practice location:
  • Phone: 609-296-1122
  • Fax: 609-296-1142
Mailing address:
  • Phone: 201-342-1205
  • Fax: 201-342-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07232600
License Number StateNJ

VIII. Authorized Official

Name: MARK GANTNER
Title or Position: MEMBER
Credential: M.D.
Phone: 201-342-1205