Healthcare Provider Details

I. General information

NPI: 1235658758
Provider Name (Legal Business Name): WEST HUDSON ANESTHESIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

181 E 73RD ST 20A
NEW YORK NY
10021-3549
US

V. Phone/Fax

Practice location:
  • Phone: 201-392-3228
  • Fax: 201-392-3526
Mailing address:
  • Phone: 718-812-4989
  • Fax: 718-387-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEONID ROSIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 718-222-5999