Provider Demographics
NPI:1164599965
Name:BROOKHAVEN ANESTHESIA ASSOCIATES, LLP
Entity Type:Organization
Organization Name:BROOKHAVEN ANESTHESIA ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:TANGUTURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-475-7680
Mailing Address - Street 1:250 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-7680
Mailing Address - Fax:631-475-7683
Practice Address - Street 1:101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-475-7680
Practice Address - Fax:631-475-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135275207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW30691Medicare ID - Type Unspecified