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General NPI Number Information
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NPI Number | 1659528586
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OFFICE ANESTHESIA, P.C
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 6532 ELLWELL CRES
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City | REGO PARK
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State | NY
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Zip | 11374-5032
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Country | US
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Telephone | 718-795-7407
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Fax |
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Provider Business Mailing Address
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Address Line | 6532 ELLWELL CRES
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City | REGO PARK
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State | NY
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Zip | 11374-5032
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Country | US
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Telephone | 718-795-7407
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAMARA SABZANOVA
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Credential | MD
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Telephone | 718-795-7407
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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 | 220227
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License Number State | NY
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