Provider Demographics
NPI:1568649150
Name:INNOVATIVE ANESTHESIA SOLUTIONS, P.C.
Entity Type:Organization
Organization Name:INNOVATIVE ANESTHESIA SOLUTIONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-822-4074
Mailing Address - Street 1:65A BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1616
Mailing Address - Country:US
Mailing Address - Phone:516-570-2306
Mailing Address - Fax:516-487-8155
Practice Address - Street 1:65A BEVERLY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1616
Practice Address - Country:US
Practice Address - Phone:516-570-2306
Practice Address - Fax:516-570-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160215207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23F641Medicare UPIN