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General NPI Number Information
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NPI Number | 1538381934
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Entity Type | Organization
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Legal Business Name | L S ANESTHESIOLOGIST P
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 75 VANDERBILT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2604
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Country | US
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Telephone | 718-979-9623
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Fax | 718-980-0628
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Provider Business Mailing Address
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Address Line | PO BOX 50196
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City | STATEN ISLAND
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State | NY
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Zip | 10305-0196
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Country | US
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Telephone | 718-979-9623
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Fax | 718-980-0628
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYDIA C SOLIDUM
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Credential | MD
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Telephone | 718-979-9623
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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 | 125296
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License Number State | NY
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