Healthcare Provider Details

I. General information

NPI: 1871551515
Provider Name (Legal Business Name): PENN ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHLAND AVE LEWISTOWN HOSPITAL
LEWISTOWN PA
17044-1167
US

IV. Provider business mailing address

118 N BEDFORD RD SUITE 200
MOUNT KISCO NY
10549-2553
US

V. Phone/Fax

Practice location:
  • Phone: 717-248-5411
  • Fax:
Mailing address:
  • Phone: 914-666-8866
  • Fax: 914-666-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GURPREET BHALLA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 914-666-8866