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General NPI Number Information
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NPI Number | 1508818014
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Entity Type | Organization
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Legal Business Name | JEFFERSON ANESTHESIOLOGIST SERVICES PC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 830 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4066
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Country | US
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Telephone | 315-785-4313
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Fax | 315-779-5114
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Provider Business Mailing Address
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Address Line | PO BOX 2001
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4501
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Country | US
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Telephone | 315-449-0513
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Fax | 315-362-5120
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BOB HAWTHORNE
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Credential |
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Telephone | 315-785-8509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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