MEDICARE: EIGHTH AVENUE ANESTHESIA PLLC

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

General Provider Information

NPI Number	:	1205267457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIGHTH AVENUE ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	8766 23RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3503
Country	:	US
Telephone Number	:	718-435-3890
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	CHANGZHENG WANG
Credential	:	M.D.
Telephone Number	:	908-922-6797

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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