Basic Information
| Provider Information | |||||||||
| NPI: | 1194167320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENGLEWOOD CLIFFS ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1532 13TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070242128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326079090 | ||||||||
| FaxNumber: | 7326071160 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 SYLVAN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD CLIFFS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076322729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012271455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2013 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHAE | ||||||||
| AuthorizedOfficialFirstName: | HUNG | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7326079090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 25MA04523900 | NJ | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.