Provider Demographics
NPI:1629170170
Name:PROFESSIONAL ANESTHESIOLOGISTS OF GREATER NEW YORK PC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIOLOGISTS OF GREATER NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KESTENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-0434
Mailing Address - Street 1:15 N BROADWAY
Mailing Address - Street 2:AREA J
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2214
Mailing Address - Country:US
Mailing Address - Phone:914-337-0434
Mailing Address - Fax:914-337-2810
Practice Address - Street 1:15 N BROADWAY
Practice Address - Street 2:AREA J
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2214
Practice Address - Country:US
Practice Address - Phone:914-337-0434
Practice Address - Fax:914-337-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35651Medicare ID - Type Unspecified