1083723191 NPI number — INNOVATIVE ANESTHESIA SOLUTIONS LLC

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 1083723191 NPI number — INNOVATIVE ANESTHESIA SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE ANESTHESIA SOLUTIONS LLC
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:
1083723191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASQUAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08736-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-899-0868
Provider Business Mailing Address Fax Number:
732-899-5167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 US HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANALAPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-8293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-358-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCALI
Authorized Official First Name:
DOMENICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-995-8552

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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