Basic Information
| Provider Information | |||||||||
| NPI: | 1649218686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TROY ANESTHESIOLOGISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3308 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142403308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668688419 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 BURDETT AVENUE | ||||||||
| Address2: | SAMARITAN HOSPITAL | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668688419 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ITENBERG | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5182713258 | ||||||||
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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 | 207L00000X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01705375 | 05 | NY | MEDICAID |