Healthcare Provider Details

I. General information

NPI: 1649360041
Provider Name (Legal Business Name): ANESTHESIA ADVANTAGE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SECOND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

IV. Provider business mailing address

12 NEWBURYPORT RD
UPPER HOLLAND PA
19053-1556
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-4110
  • Fax: 267-295-8208
Mailing address:
  • Phone: 215-860-4110
  • Fax: 267-295-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN G CARESTIA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 267-566-1914