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General NPI Number Information
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NPI Number | 1104243039
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Entity Type | Organization
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Legal Business Name | MONOCACY ANESTHESIA COMPANY LLC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 80 MILL ST
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City | NEWTON
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State | NJ
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Zip | 07860-1411
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Country | US
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Telephone | 973-579-1660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-0270
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL G. CARUTHERS
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Credential | M.D.
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Telephone | 240-675-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA07863200
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License Number State | NJ
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