MEDICARE: NEW YORK 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

General Provider Information

NPI Number	:	1649148503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK AMBULATORY ANESTHESIA, PLLC

Provider Business Mailing Address
First Line	:	16 S BEDFORD RD STE 3W
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3464
Country	:	US
Telephone Number	:	914-238-5884
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 S BEDFORD RD STE 3W
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-3464
Country	:	US
Telephone Number	:	914-238-5884
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD BROCCOLI
Credential	:	MD
Telephone Number	:	914-238-5884

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	10/23/2025

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