Provider Demographics
NPI:1003053067
Name:DREAMLAND ANESTHESIA LIMITED LIABILITY CO
Entity Type:Organization
Organization Name:DREAMLAND ANESTHESIA LIMITED LIABILITY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-829-6902
Mailing Address - Street 1:346 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6055
Mailing Address - Country:US
Mailing Address - Phone:732-605-1237
Mailing Address - Fax:730-605-1238
Practice Address - Street 1:346 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6055
Practice Address - Country:US
Practice Address - Phone:732-605-1237
Practice Address - Fax:732-605-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04131700207L00000X
NJMA41241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty