MEDICARE: WESTCHESTER AMBULATORY 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	1439052	NY
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	193448	NY
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	1439052	NY
4	207LP3000X	Pediatric Anesthesiology Physician	193448	NY
5	207LP3000X	Pediatric Anesthesiology Physician	1439052	NY
6	207L00000X	Anesthesiology Physician	193448	NY

General Provider Information

NPI Number	:	1538616487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCHESTER AMBULATORY ANESTHESIA, PLLC

Provider Business Mailing Address
First Line	:	16 S BEDFORD RD
Second Line	:	SUITE 3W
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3464
Country	:	US
Telephone Number	:	914-844-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 S BEDFORD RD
Second Line	:	SUITE 3W
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3464
Country	:	US
Telephone Number	:	914-844-2864
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD BROCCOLI
Credential	:	MD
Telephone Number	:	914-844-2864

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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