Provider Demographics
NPI:1225323967
Name:OLD BRIDGE ANESTHESIOLOGY PC
Entity Type:Organization
Organization Name:OLD BRIDGE ANESTHESIOLOGY PC
Other - Org Name:BAY PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-1205
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-0135
Mailing Address - Country:US
Mailing Address - Phone:201-342-1205
Mailing Address - Fax:201-342-1259
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:201-342-1205
Practice Address - Fax:201-342-1259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD BRIDGE ANESTHESIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty