Healthcare Provider Details

I. General information

NPI: 1336253178
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF BAY RIDGE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 92ND ST
BROOKLYN NY
11228-3619
US

IV. Provider business mailing address

PO BOX 32161
HARTFORD CT
06150-2161
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-1480
  • Fax:
Mailing address:
  • Phone: 201-487-7227
  • Fax: 201-487-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PETR SABZANOV
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-567-1480