Healthcare Provider Details

I. General information

NPI: 1225330103
Provider Name (Legal Business Name): BRONX ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2010
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

450 MAMARONECK AVE STE 201
HARRISON NY
10528-2436
US

V. Phone/Fax

Practice location:
  • Phone: 877-580-4635
  • Fax: 718-960-3748
Mailing address:
  • Phone: 914-637-2075
  • 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: MARC KOCH
Title or Position: CEO
Credential:
Phone: 877-476-6642