Provider Demographics
NPI:1548593320
Name:INTERBOROUGH ANESTHESIA
Entity Type:Organization
Organization Name:INTERBOROUGH ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FENAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THEMISTOCLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-450-0424
Mailing Address - Street 1:4626 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1327
Mailing Address - Country:US
Mailing Address - Phone:917-450-0424
Mailing Address - Fax:
Practice Address - Street 1:4626 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1610
Practice Address - Country:US
Practice Address - Phone:917-450-0424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY217744OtherLICENSE