Provider Demographics
NPI:1437473170
Name:MIDTOWN ANESTHESIA PC
Entity Type:Organization
Organization Name:MIDTOWN ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-558-3613
Mailing Address - Street 1:227 EAST 56TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3733
Mailing Address - Country:US
Mailing Address - Phone:646-558-3613
Mailing Address - Fax:716-242-1912
Practice Address - Street 1:227 EAST 56TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3733
Practice Address - Country:US
Practice Address - Phone:646-558-3613
Practice Address - Fax:716-242-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG17642Medicare UPIN