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General NPI Number Information
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NPI Number | 1962816728
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Entity Type | Organization
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Legal Business Name | NORTHEAST AMBULATORY ANESTHESIA PLLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 55 GALILEO DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2776
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Country | US
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Telephone | 716-553-6931
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Fax |
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Provider Business Mailing Address
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Address Line | 55 GALILEO DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2776
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Country | US
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Telephone | 716-553-6931
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ROSE BERKUN
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Credential | M.D.
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Telephone | 716-553-6931
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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 |
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License Number State |
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