=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346489028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE ANESTHESIA SERVICES, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2009
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 954 LEXINGTON AVE SUITE 295
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-879-1705
-----------------------------------------------------
Fax | 212-879-4025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 954 LEXINGTON AVE SUITE 295
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-879-1705
-----------------------------------------------------
Fax | 212-879-4025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | LAWRENCE M HOLTZIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-879-1705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 190187
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------