MEDICARE: ANESTHESIA SPECIALTY SERVICES, PC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	174778	NY

General Provider Information

NPI Number	:	1053603605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA SPECIALTY SERVICES, PC

Provider Business Mailing Address
First Line	:	1063 E 14TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4301
Country	:	US
Telephone Number	:	718-258-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3150
Country	:	US
Telephone Number	:	201-339-1700
Fax Number	:	201-339-6972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD ALFRED
Credential	:	M.D.
Telephone Number	:	718-258-3379

Provider Enumeration Date	:	05/13/2011
Last Update Date	:	01/04/2012

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