1104866698 NPI number — DEER PARK ANESTHESIA GROUP, LLP.

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 1104866698 NPI number — DEER PARK ANESTHESIA GROUP, LLP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEER PARK ANESTHESIA GROUP, LLP.
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:
1104866698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CATHARINE ST
Provider Second Line Business Mailing Address:
P.O. BOX 550
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-885-2318
Provider Business Mailing Address Fax Number:
845-790-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E MAIN ST
Provider Second Line Business Practice Location Address:
BON SECOURS COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-858-7000
Provider Business Practice Location Address Fax Number:
845-790-2675
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OMAR
Authorized Official First Name:
HUSSEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
866-885-2318

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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)

  • Identifier: 02728861 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com