Healthcare Provider Details

I. General information

NPI: 1255449955
Provider Name (Legal Business Name): EMPIRE ANSTHS MEDCL CONSLNTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 OAKTREE LN
NISKAYUNA NY
12309-1825
US

IV. Provider business mailing address

41 OAKTREE LN
NISKAYUNA NY
12309-1825
US

V. Phone/Fax

Practice location:
  • Phone: 518-221-0646
  • Fax:
Mailing address:
  • Phone: 518-221-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: HOSAHALLY NAGARAJ
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 518-221-0646