Healthcare Provider Details

I. General information

NPI: 1457625980
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ROUTE 25A STE 225
ROCKY POINT NY
11778-8802
US

IV. Provider business mailing address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2502
US

V. Phone/Fax

Practice location:
  • Phone: 631-736-4064
  • Fax: 631-736-1332
Mailing address:
  • Phone: 631-736-4064
  • Fax: 631-736-1332

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. FREDERIC JAY MATLIN
Title or Position: PARTNER
Credential:
Phone: 631-736-4064