=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215320734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARDSLEY ANESTHESIA & PAIN MANAGEMENT SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2015
-----------------------------------------------------
Last Update Date | 03/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 SUMNER PL
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11206-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-222-5999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7A WESTERN DR
-----------------------------------------------------
City | ARDSLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10502-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | ABDUL KHOKHAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-222-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------