Provider Demographics
NPI:1093182495
Name:SYNERGY ANESTHESIA ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SYNERGY ANESTHESIA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCDOUALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MS
Authorized Official - Phone:856-451-3552
Mailing Address - Street 1:133 GAITHER DR STE K
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1710
Mailing Address - Country:US
Mailing Address - Phone:856-451-3552
Mailing Address - Fax:856-358-8053
Practice Address - Street 1:133 GAITHER DR STE K
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1710
Practice Address - Country:US
Practice Address - Phone:856-451-3552
Practice Address - Fax:856-358-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08575500261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty