Provider Demographics
NPI:1003053794
Name:EAST COAST ANESTHESIA PC
Entity Type:Organization
Organization Name:EAST COAST ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-716-7107
Mailing Address - Street 1:2637 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6208
Mailing Address - Country:US
Mailing Address - Phone:917-306-8073
Mailing Address - Fax:
Practice Address - Street 1:2512 148TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1433
Practice Address - Country:US
Practice Address - Phone:717-716-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246186207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02584614Medicaid
NYI19874Medicare UPIN
NY02584614Medicaid