=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982927349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COURT HOUSE ANESTHESIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2010
-----------------------------------------------------
Last Update Date | 03/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 DORY DR
-----------------------------------------------------
City | CAPE MAY COURT HOUSE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08210-2057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-653-9399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 DORY DR
-----------------------------------------------------
City | CAPE MAY COURT HOUSE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08210-2057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-653-9399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ANTONIOS THALASSINOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-653-9399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------