Basic Information
| Provider Information | |||||||||
| NPI: | 1760403646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANANDAIGUA ANESTHESIA ASSOCIATES LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 GATES RD STE 3 | ||||||||
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| City: | VESTAL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138502288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075847387 | ||||||||
| FaxNumber: | 6077721223 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 PARRISH ST | ||||||||
| Address2: | |||||||||
| City: | CANANDAIGUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144241731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853966574 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 12/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5853966565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01599059 | 05 | NY | MEDICAID |