1861799587 NPI number — SOUTH SHORE ANESTHESIOLOGY, P.C.

Table of content: (NPI 1861799587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861799587 NPI number — SOUTH SHORE ANESTHESIOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE ANESTHESIOLOGY, P.C.
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:
1861799587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6809 174TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11365-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-886-7955
Provider Business Mailing Address Fax Number:
718-886-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18811 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-264-6869
Provider Business Practice Location Address Fax Number:
718-264-6833
Provider Enumeration Date:
02/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOBO
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-886-7955

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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