Provider Demographics
NPI:1245464924
Name:KIPS BAY ANESTHESIA PC
Entity type:Organization
Organization Name:KIPS BAY ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ANESTHESIA
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONKCOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-889-5477
Mailing Address - Street 1:535 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8275
Mailing Address - Country:US
Mailing Address - Phone:212-889-5477
Mailing Address - Fax:212-889-0517
Practice Address - Street 1:535 2ND AVE
Practice Address - Street 2:KIPS BAY ANESTHESIA PC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8275
Practice Address - Country:US
Practice Address - Phone:212-889-5477
Practice Address - Fax:212-889-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102431207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty