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General NPI Number Information
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NPI Number | 1508910217
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Entity Type | Organization
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Legal Business Name | QUALITY ANESTHESIA ASSOCIATES LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 5 5TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7368
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Country | US
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Telephone | 631-446-1190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | ISLIP
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State | NY
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Zip | 11751-0577
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Country | US
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Telephone | 631-446-1190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MISSIG
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Credential | CRNA
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Telephone | 631-446-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 446026-1
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License Number State | NY
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