=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114934213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANESTHESIA AND PAIN MANAGEMENT GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2006
-----------------------------------------------------
Last Update Date | 06/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 187 MILLBURN AVE SUITE 103
-----------------------------------------------------
City | MILLBURN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07041-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-467-1466
-----------------------------------------------------
Fax | 973-467-1422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 551420
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33355-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-507-5244
-----------------------------------------------------
Fax | 954-858-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | WILLIAM C. HAWK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-243-3839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------