Basic Information
| Provider Information | |||||||||
| NPI: | 1194753707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENN ANESTHESIA SERVICES, PC-CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 KENSICO DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105491009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146668866 | ||||||||
| FaxNumber: | 9146666777 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HIGHLAND AVE | ||||||||
| Address2: | LEWISTOWN HOSPITAL | ||||||||
| City: | LEWISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170441167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172485411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | BHALLA | ||||||||
| AuthorizedOfficialFirstName: | GURPREET | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9146668866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 01732624 | 05 | PA | MEDICAID | 1007298600009 | 05 | PA | MEDICAID |