=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447599378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANESTHESIA ASSOCIATES OF PARK AVENUE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2013
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 E 91ST ST SUITE 1C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-566-0899
-----------------------------------------------------
Fax | 212-860-3582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 EAST 91ST STREET SUITE 1C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-566-0899
-----------------------------------------------------
Fax | 212-860-3582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES MIHALCIK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-566-0899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A152928
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------