Provider Demographics
NPI:1851460463
Name:OUTPATIENT ANESTHESIA SPECIALISTS L.L.C
Entity Type:Organization
Organization Name:OUTPATIENT ANESTHESIA SPECIALISTS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-661-0570
Mailing Address - Street 1:225 MAY ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-661-0570
Mailing Address - Fax:732-661-0084
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:UNIT C
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-661-0570
Practice Address - Fax:732-661-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070001Medicare ID - Type Unspecified