Healthcare Provider Details

I. General information

NPI: 1518952902
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 RTE 23
WAYNE NJ
07470-7510
US

IV. Provider business mailing address

PO BOX 1593
SECAUCUS NJ
07096-1593
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-1484
  • Fax:
Mailing address:
  • Phone: 201-635-1003
  • Fax: 201-635-1332

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: BRIDGET CHAMPINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-635-1003