Healthcare Provider Details

I. General information

NPI: 1912349317
Provider Name (Legal Business Name): NORTHEAST ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 RUGBY RD
BROOKLYN NY
11230-1581
US

IV. Provider business mailing address

1408 E 34TH ST
BROOKLYN NY
11210-5428
US

V. Phone/Fax

Practice location:
  • Phone: 718-233-1164
  • Fax: 718-228-5645
Mailing address:
  • Phone: 718-233-1164
  • Fax: 718-228-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number243503
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AHARON GUTTERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-233-1164