Provider Demographics
NPI:1801832282
Name:PROFESSIONAL ANESTHESIOLOGY SERVICES, PA
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIOLOGY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-779-7361
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-0458
Mailing Address - Country:US
Mailing Address - Phone:973-779-7361
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:211 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4617
Practice Address - Country:US
Practice Address - Phone:973-470-3598
Practice Address - Fax:973-470-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7979401Medicaid
NJ7979401Medicaid