Provider Demographics
NPI:1710291463
Name:CENTRE STREET OFFICE-BASED SURGERY, PLLC
Entity Type:Organization
Organization Name:CENTRE STREET OFFICE-BASED SURGERY, PLLC
Other - Org Name:139 CENTRE STREET OFFICE-BASED SURGERY, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-541-3225
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 609
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4408
Practice Address - Country:US
Practice Address - Phone:917-541-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty