Basic Information
Provider Information | |||||||||
NPI: | 1285700070 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AMBOY ANESTHESIA ASSOC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 997 | ||||||||
Address2: |   | ||||||||
City: | OLD BRIDGE | ||||||||
State: | NJ | ||||||||
PostalCode: | 08857 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7328264177 | ||||||||
FaxNumber: | 7326071160 | ||||||||
Practice Location | |||||||||
Address1: | 530 NEW BRUNSWICK AVE | ||||||||
Address2: |   | ||||||||
City: | PERTH AMBOY | ||||||||
State: | NJ | ||||||||
PostalCode: | 08861 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7324423700 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/27/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAIAI | ||||||||
AuthorizedOfficialFirstName: | KALPANA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT MD | ||||||||
AuthorizedOfficialTelephone: | 7328264177 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA07600400 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 0064190 | 05 | NJ |   | MEDICAID |