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General NPI Number Information
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NPI Number | 1447433958
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Entity Type | Organization
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Legal Business Name | RIVERSIDE ANESTHESIA
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 2500 RTE 347 BLDG 24C
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 212-877-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 263 W END AVE STE 22B
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City | NEW YORK
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State | NY
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Zip | 10023-2612
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Country | US
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Telephone | 212-877-3778
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARC JOSEPH YLAND
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Credential | M.D.
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Telephone | 212-877-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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