Healthcare Provider Details
I. General information
NPI: 1952779217
Provider Name (Legal Business Name): CARE FIRST ANESTHESIA PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
404 POTTER BLVD
BRIGHTWATERS NY
11718-1830
US
IV. Provider business mailing address
761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US
V. Phone/Fax
- Phone: 631-376-0055
- Fax:
- Phone: 631-736-4064
- Fax: 631-736-1332
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ADAM
BRIAN
LESSER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-736-4064