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General NPI Number Information
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NPI Number | 1508812892
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Entity Type | Organization
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Legal Business Name | JAMAICA ANESTHESIOLOGIST, PC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 8900 VAN WYCK EXPY
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City | JAMAICA
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State | NY
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Zip | 11418-2897
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Country | US
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Telephone | 718-206-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 80 MARCUS DR PROVIDER ENROLLMENT
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City | MELVILLE
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State | NY
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Zip | 11747-4230
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Country | US
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Telephone | 631-391-7700
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Fax | 631-454-4163
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTOINETTE MORISCO
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Credential | MD
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Telephone | 718-206-6088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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