Healthcare Provider Details

I. General information

NPI: 1063730927
Provider Name (Legal Business Name): TEANECK ANESTHESIA GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-4350
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-7149
  • Fax: 201-833-6576
Mailing address:
  • Phone: 201-833-7149
  • Fax: 201-833-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ALAN GWERTZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-833-7149