Basic Information
| Provider Information | |||||||||
| NPI: | 1831184225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA ASSOCIATES AT ST. MICHAEL'S, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1593 | ||||||||
| Address2: | |||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070961593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016351003 | ||||||||
| FaxNumber: | 2016351332 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071022011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738775034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | CHAMPINO | ||||||||
| AuthorizedOfficialFirstName: | BRIDGET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2016351003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8804702 | 05 | NJ | MEDICAID |