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General NPI Number Information
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NPI Number | 1548593320
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Entity Type | Organization
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Legal Business Name | INTERBOROUGH ANESTHESIA
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 4626 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10470-1610
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Country | US
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Telephone | 917-450-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 4626 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10470-1327
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Country | US
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Telephone | 917-450-0424
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FENAR THEMISTOCLE
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Credential | M.D.
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Telephone | 917-450-0424
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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 | 217744
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License Number State | NY
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