Healthcare Provider Details

I. General information

NPI: 1679527634
Provider Name (Legal Business Name): ST. BARNABAS ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE MAIN BLDG, 2ND FLOOR
BRONX NY
10457-2545
US

IV. Provider business mailing address

PO BOX 3048
BUFFALO NY
14240-3048
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6238
  • Fax: 718-960-3748
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BILLY FORD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-960-6238