Provider Demographics
NPI:1255449955
Name:EMPIRE ANSTHS MEDCL CONSLNTS
Entity type:Organization
Organization Name:EMPIRE ANSTHS MEDCL CONSLNTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOSAHALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-221-0646
Mailing Address - Street 1:41 OAKTREE LN
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1825
Mailing Address - Country:US
Mailing Address - Phone:518-221-0646
Mailing Address - Fax:
Practice Address - Street 1:41 OAKTREE LN
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1825
Practice Address - Country:US
Practice Address - Phone:518-221-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5773443OtherAETNA
NY01546285Medicaid
NY359677600OtherUSDOL
NY5301669OtherGHI
NYE927OtherCDPHP
NY5773443OtherAETNA
NY01546285Medicaid