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General NPI Number Information
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NPI Number | 1831184225
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Entity Type | Organization
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Legal Business Name | ANESTHESIA ASSOCIATES AT ST. MICHAEL'S, LLC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 268 MARTIN LUTHER KING JR BLVD
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City | NEWARK
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State | NJ
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Zip | 07102-2011
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Country | US
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Telephone | 973-877-5034
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1593
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City | SECAUCUS
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State | NJ
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Zip | 07096-1593
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Country | US
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Telephone | 201-635-1003
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Fax | 201-635-1332
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRIDGET CHAMPINO
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Credential |
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Telephone | 201-635-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State | NJ
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