Healthcare Provider Details

I. General information

NPI: 1003183344
Provider Name (Legal Business Name): PENNSYLVANIA ANESTHESIA SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CENTER AVE # 4
SOMERSET PA
15501-2088
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5253
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-5000
  • Fax:
Mailing address:
  • Phone: 914-637-3530
  • Fax: 914-560-2227

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 Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC E. KOCH
Title or Position: PRESIDENT & CEO
Credential: M.D
Phone: 914-637-3511