Basic Information
| Provider Information | |||||||||
| NPI: | 1285606616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKLYN KINGS HIGHWAY ANESTHESIOLOGISTS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270 | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117620270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312642035 | ||||||||
| FaxNumber: | 6312641418 | ||||||||
| Practice Location | |||||||||
| Address1: | BETH ISRAEL MEDICAL CENTER/KINGS HIGHWAY DIVISION | ||||||||
| Address2: | 3201 KINGS HIGHWAY | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189513072 | ||||||||
| FaxNumber: | 7189513074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | PILLALAMARRI | ||||||||
| AuthorizedOfficialFirstName: | ESWAR | ||||||||
| AuthorizedOfficialMiddleName: | DUTT | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OF ANESTHESIA | ||||||||
| AuthorizedOfficialTelephone: | 7189513072 | ||||||||
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| 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 | 01814488 | 05 | NY | MEDICAID |