=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285606616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKLYN KINGS HIGHWAY ANESTHESIOLOGISTS, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 02/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BETH ISRAEL MEDICAL CENTER/KINGS HIGHWAY DIVISION 3201 KINGS HIGHWAY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-951-3072
-----------------------------------------------------
Fax | 718-951-3074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270
-----------------------------------------------------
City | MASSAPEQUA PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11762-0270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-264-2035
-----------------------------------------------------
Fax | 631-264-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF ANESTHESIA
-----------------------------------------------------
Name | DR. ESWAR DUTT PILLALAMARRI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-951-3072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------