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General NPI Number Information
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NPI Number | 1740711795
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Entity Type | Organization
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Legal Business Name | EAST RIVER ANESTHESIOLOGY INC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 109 MORRISON DR
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City | PRINCETON
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State | WV
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Zip | 24740-2322
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Country | US
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Telephone | 304-487-3559
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Fax | 304-487-7928
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Provider Business Mailing Address
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Address Line | PO BOX 1143
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City | PRINCETON
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State | WV
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Zip | 24740-1143
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Country | US
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Telephone | 304-487-3559
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Fax | 304-487-7928
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KENNETH PARKER
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Credential | M.D.
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Telephone | 304-487-3559
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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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