Provider Demographics
NPI:1215191192
Name:MOBILE ANESTHESIA, INC
Entity Type:Organization
Organization Name:MOBILE ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:215-208-7751
Mailing Address - Street 1:1225 LINDENHURST RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5406
Mailing Address - Country:US
Mailing Address - Phone:215-208-7751
Mailing Address - Fax:
Practice Address - Street 1:1225 LINDENHURST RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5406
Practice Address - Country:US
Practice Address - Phone:215-208-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007559Medicare PIN