Healthcare Provider Details

I. General information

NPI: 1710500327
Provider Name (Legal Business Name): SPARTAN ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 170TH ST
FRESH MEADOWS NY
11365-3333
US

IV. Provider business mailing address

7103 170TH ST
FRESH MEADOWS NY
11365-3333
US

V. Phone/Fax

Practice location:
  • Phone: 917-568-8809
  • Fax: 800-557-3140
Mailing address:
  • Phone: 917-568-8809
  • Fax: 800-557-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSHUA SISSER
Title or Position: PROVIDER AND OWNER
Credential: M.D.
Phone: 917-568-8809