MEDICARE: LIBERTY ANAESTHESIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	188351	NY

General Provider Information

NPI Number	:	1023373131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY ANAESTHESIA

Provider Business Mailing Address
First Line	:	2 CATHARINE ST
Second Line	:	P.O. BOX 550
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-3100
Country	:	US
Telephone Number	:	845-790-2661
Fax Number	:	845-790-2675

Provider Business Practice Location Address
First Line	:	136 SAGAMORE RD
Second Line	:	DR DAVID
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-4009
Country	:	US
Telephone Number	:	914-337-6400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUBHASH SAMANT
Credential	:	MD
Telephone Number	:	845-790-2661

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

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Directions to “LIBERTY ANAESTHESIA ” Practice Location

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