Provider Demographics
NPI:1649218686
Name:TROY ANESTHESIOLOGISTS, PC
Entity Type:Organization
Organization Name:TROY ANESTHESIOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ITENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-271-3258
Mailing Address - Street 1:PO BOX 3308
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3308
Mailing Address - Country:US
Mailing Address - Phone:866-868-8419
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:2215 BURDETT AVENUE
Practice Address - Street 2:SAMARITAN HOSPITAL
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:866-868-8419
Practice Address - Fax:845-790-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01705375Medicaid
NY56454AMedicare ID - Type Unspecified