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General NPI Number Information
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NPI Number | 1770006306
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Entity Type | Organization
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Legal Business Name | KINGS ANESTHESIA
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 727 JORALEMON ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1455
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Country | US
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Telephone | 973-450-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 359 WEBSTER AVE UNIT 2
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City | JERSEY CITY
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State | NJ
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Zip | 07307-1009
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Country | US
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Telephone | 917-270-1655
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | EMMANUEL RODRIGUEZ
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Credential | MD
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Telephone | 917-270-1655
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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 | 25MA09073500
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License Number State | NJ
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