MEDICARE: NY SURGICAL & ANESTHESIA SUITES 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	261QA1903X	Ambulatory Surgical Clinic/Center	203113	NY

General Provider Information

NPI Number	:	1780810150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY SURGICAL & ANESTHESIA SUITES PC

Provider Business Mailing Address
First Line	:	3620 E TREMONT AVE
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-792-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 E TREMONT AVE
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-792-4878
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. BRIAN HAFTEL
Credential	:	MD
Telephone Number	:	917-886-8215

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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