MEDICARE: BROOKLYN ANESTHESIA GROUP 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1669607123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN ANESTHESIA GROUP PC

Provider Business Mailing Address
First Line	:	565 CONWAY RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3519
Country	:	US
Telephone Number	:	718-433-0044
Fax Number	:	718-255-6555

Provider Business Practice Location Address
First Line	:	765 NOSTRAND AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4203
Country	:	US
Telephone Number	:	718-433-0044
Fax Number	:	718-255-6555

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GINA DUVAL
Credential	:
Telephone Number	:	718-433-0044

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	10/30/2025

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