Healthcare Provider Details

I. General information

NPI: 1417661067
Provider Name (Legal Business Name): ANESTAT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BROOK AVE STE 203
BRONX NY
10451-4209
US

IV. Provider business mailing address

185 KINGSLAND ST
NUTLEY NJ
07110-1119
US

V. Phone/Fax

Practice location:
  • Phone: 855-699-7246
  • Fax:
Mailing address:
  • Phone: 973-542-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. NEESHA N MOHAMMED
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 201-340-2199