Provider Demographics
NPI:1346227543
Name:PENN VALLEY ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PENN VALLEY ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:856-451-3552
Mailing Address - Street 1:1000 WHITE HORSE RD STE 612
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4412
Mailing Address - Country:US
Mailing Address - Phone:856-451-3552
Mailing Address - Fax:856-358-8053
Practice Address - Street 1:1000 WHITE HORSE RD STE 612
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4412
Practice Address - Country:US
Practice Address - Phone:856-845-1355
Practice Address - Fax:856-358-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014588880001Medicaid
PA1014588880001Medicaid