=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851423529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLENNIUM ANESTHESIA CONSULTANTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 07/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 LYONS AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07112-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-926-7143
-----------------------------------------------------
Fax | 73-926-2699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 LYONS AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07112-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-926-7143
-----------------------------------------------------
Fax | 73-926-2699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN M. MORRIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-926-7143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA03737600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------