=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194778084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST END ANESTHESIOLOGISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 06/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 HERRICK ROAD
-----------------------------------------------------
City | SOUTHAMPTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11968-5045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-726-8350
-----------------------------------------------------
Fax | 631-726-8519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 SUNRISE HWY STE 200
-----------------------------------------------------
City | GREAT RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11739-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-907-2186
-----------------------------------------------------
Fax | 631-201-3179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. JEFFREY M. MULLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-726-8350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------