=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083746259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESOURCE ANESTHESIOLOGY ASSOC OF CALIFORNIA,A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 TRUXTUN AVE
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-637-2063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 MAMARONECK AVE STE 201
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10528-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-637-2063
-----------------------------------------------------
Fax | 914-365-6307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | DR. MARC E. KOCH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 914-637-3511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------