Basic Information
| Provider Information | |||||||||
| NPI: | 1083740591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESSEX ANESTHESIOLISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1406 | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070031406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732681400 | ||||||||
| FaxNumber: | 9732685838 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071071317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732681400 | ||||||||
| FaxNumber: | 9732685838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHOI | ||||||||
| AuthorizedOfficialFirstName: | BONG HO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9732681400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3373703 | 05 | NJ | MEDICAID |