Healthcare Provider Details

I. General information

NPI: 1689746646
Provider Name (Legal Business Name): FRC ANESTHESIA GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 E 13TH ST SUITE 1A
BROOKLYN NY
11229-2807
US

IV. Provider business mailing address

108 BURNHAM AVE
ROSLYN HEIGHTS NY
11577-1935
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-8300
  • Fax: 718-627-8302
Mailing address:
  • Phone: 917-697-7817
  • Fax: 516-625-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number232855
License Number StateNY

VIII. Authorized Official

Name: DR. ALEKSANDR ROZENBERG
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 917-697-7817