1922123132 NPI number — SPECIALTY ANESTHESIA INTERVENTIONS, PC

Table of content: (NPI 1922123132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922123132 NPI number — SPECIALTY ANESTHESIA INTERVENTIONS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY ANESTHESIA INTERVENTIONS, PC
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:
1922123132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7211 AUSTIN ST
Provider Second Line Business Mailing Address:
#481
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-5354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-255-2333
Provider Business Mailing Address Fax Number:
212-255-2455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SAINT NICHOLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237-4039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-628-4057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UPADHYAYULA
Authorized Official First Name:
SEKHAR
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-255-2333

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  209101 , 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: 01990601 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1068641 . This is a "AETNA USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00209101 . This is a "METROPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3575367 . This is a "AETNA USHC (COMMERCIAL)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 902285001 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0385T . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 175973 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 209101 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N299460 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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