1255810347 NPI number — COBBLE HILL ANESTHESIA PLLC

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 1255810347 NPI number — COBBLE HILL ANESTHESIA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COBBLE HILL ANESTHESIA PLLC
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:
1255810347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 E COBBLE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUDONVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12211-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-325-3286
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1182 TROY SCHENECTADY RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-649-8082
Provider Business Practice Location Address Fax Number:
518-649-8123
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DELISIO
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING/BILLING MANAGER
Authorized Official Telephone Number:
518-649-8082

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  262197-1 , 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: 05419961 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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