1457625980 NPI number — AMBULATORY ANESTHESIA ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457625980 NPI number — AMBULATORY ANESTHESIA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULATORY ANESTHESIA ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457625980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 MIDDLE COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-736-4064
Provider Business Mailing Address Fax Number:
631-736-1332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 ROUTE 25A STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11778-8802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-736-4064
Provider Business Practice Location Address Fax Number:
631-736-1332
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MATLIN
Authorized Official First Name:
FREDERIC
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
631-736-4064

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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