Healthcare Provider Details

I. General information

NPI: 1952691115
Provider Name (Legal Business Name): SCRANTON ANESTHESIA SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ADAMS AVE
SCRANTON PA
18510-2001
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5253
US

V. Phone/Fax

Practice location:
  • Phone: 570-504-8100
  • Fax:
Mailing address:
  • Phone: 914-637-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARC E KOCH
Title or Position: CEO
Credential: MD
Phone: 914-637-3511