Healthcare Provider Details

I. General information

NPI: 1396002556
Provider Name (Legal Business Name): NY MONITORED ANESTHESIA CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 THE DELL
ALBERTSON NY
11507-1041
US

IV. Provider business mailing address

134 THE DELL
ALBERTSON NY
11507-1041
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-1600
  • Fax: 718-224-8085
Mailing address:
  • Phone: 718-224-1600
  • Fax: 718-224-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number185465
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. HAN S LEE
Title or Position: OWNER
Credential: M.D.
Phone: 718-224-1600