Healthcare Provider Details

I. General information

NPI: 1881871630
Provider Name (Legal Business Name): LYNBROOK ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 31ST AVE
ASTORIA NY
11103-1842
US

IV. Provider business mailing address

450 MAMARONECK AVE STE 201
HARRISON NY
10528-2436
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-5050
  • Fax: 718-545-5052
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC E. KOCH
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 914-637-3511