Healthcare Provider Details

I. General information

NPI: 1083881767
Provider Name (Legal Business Name): RARITAN ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 CHESTNUT ST
UNION NJ
07083-7200
US

IV. Provider business mailing address

PO BOX 417012
BOSTON MA
02241-7012
US

V. Phone/Fax

Practice location:
  • Phone: 908-851-8602
  • Fax: 908-686-8758
Mailing address:
  • Phone: 908-851-8602
  • Fax: 908-686-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. STEVEN SHANE
Title or Position: PRESIDENT
Credential: MD
Phone: 908-851-8602