Healthcare Provider Details

I. General information

NPI: 1992441067
Provider Name (Legal Business Name): DECENNIAL ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEAN DRIVE LOWER LEVEL UNIT 1N
TENAFLY NJ
07670
US

IV. Provider business mailing address

2 DEAN DRIVE LOWER LEVEL UNIT 1N
TENAFLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-592-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON CHIU
Title or Position: OWNER
Credential: MD
Phone: 973-718-0211