Healthcare Provider Details

I. General information

NPI: 1891710653
Provider Name (Legal Business Name): PHOENIX ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERVIEW PLZ
RED BANK NJ
07701-1864
US

IV. Provider business mailing address

PO BOX 297
MANASQUAN NJ
08736-0297
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-2700
  • Fax:
Mailing address:
  • Phone: 732-899-0868
  • Fax: 732-899-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07281800
License Number StateNJ

VIII. Authorized Official

Name: LIN ZHAO
Title or Position: OWNER
Credential: MD
Phone: 732-899-0868