=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861799587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH SHORE ANESTHESIOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2011
-----------------------------------------------------
Last Update Date | 02/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18811 HILLSIDE AVE
-----------------------------------------------------
City | HOLLIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11423-1935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-264-6869
-----------------------------------------------------
Fax | 718-264-6833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6809 174TH ST
-----------------------------------------------------
City | FRESH MEADOWS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-886-7955
-----------------------------------------------------
Fax | 718-886-7953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SYLVIA J. LOBO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-886-7955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------