Healthcare Provider Details

I. General information

NPI: 1457757072
Provider Name (Legal Business Name): CENTURION BROOKLYN ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WILSON ST
VALLEY STREAM NY
11581-3527
US

IV. Provider business mailing address

811 WILSON ST
VALLEY STREAM NY
11581-3527
US

V. Phone/Fax

Practice location:
  • Phone: 718-550-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AVISHAI NEUMAN
Title or Position: TREASURER
Credential:
Phone: 718-550-8600