Provider Demographics
NPI:1447599378
Name:ANESTHESIA ASSOCIATES OF PARK AVENUE
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF PARK AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-566-0899
Mailing Address - Street 1:407 EAST 91ST STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:917-566-0899
Mailing Address - Fax:212-860-3582
Practice Address - Street 1:407 E 91ST ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6806
Practice Address - Country:US
Practice Address - Phone:917-566-0899
Practice Address - Fax:212-860-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA152928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00970296Medicaid
NY00970296Medicaid