=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851754378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW JERSEY ANESTHESIA AND PAIN MANAGEMENT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2016
-----------------------------------------------------
Last Update Date | 04/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 PROFESSIONAL VIEW DR BUILDING 100
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-7902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-577-9126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 E 34TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AHARON GUTTERMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-598-4756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | NJ25MA08267600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------