Provider Demographics
NPI:1003935693
Name:NORTHEASTERN ANESTHESIA OF NEW JERSEY, PC
Entity Type:Organization
Organization Name:NORTHEASTERN ANESTHESIA OF NEW JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-666-8866
Mailing Address - Street 1:118 N BEDFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2553
Mailing Address - Country:US
Mailing Address - Phone:914-666-8866
Mailing Address - Fax:914-666-6777
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:SURGICARE SURGICAL ASSOCIATES OF MAHWAH, LLC
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:914-666-8866
Practice Address - Fax:914-666-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129453Medicaid
NJ0129453Medicaid