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General NPI Number Information
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NPI Number | 1205092459
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Entity Type | Organization
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Legal Business Name | TRI-STATE ANESTHESIA
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 425 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10016-2223
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Country | US
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Telephone | 201-804-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48180
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City | NEWARK
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State | NJ
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Zip | 07101-8380
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Country | US
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Telephone | 201-804-2800
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JILL YOUNG
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Credential | MD
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Telephone | 201-804-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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