Provider Demographics
NPI:1881636397
Name:INTEGRATED ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTEGRATED ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF ANESTHESIA TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-929-7353
Mailing Address - Street 1:2 CORPORATE DRIVE 9TH FLOOR
Mailing Address - Street 2:SUITE 955
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7623
Mailing Address - Country:US
Mailing Address - Phone:203-929-7353
Mailing Address - Fax:203-929-0756
Practice Address - Street 1:2 CORPORATE DRIVE 9TH FLOOR
Practice Address - Street 2:SUITE 955
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7623
Practice Address - Country:US
Practice Address - Phone:203-929-7353
Practice Address - Fax:203-929-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004081725Medicaid
CT004081725Medicaid