1184028508 NPI number — METROPOLITAN ANESTHESIA SERVICES

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 1184028508 NPI number — METROPOLITAN ANESTHESIA SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN ANESTHESIA SERVICES
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:
1184028508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11231-4353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-422-5023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 E 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-861-1203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KUSHNERIK
Authorized Official First Name:
VADIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, PAIN MANAGEMENT SERVICES
Authorized Official Telephone Number:
718-807-6995

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  217486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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