Provider Demographics
NPI:1255810347
Name:COBBLE HILL ANESTHESIA PLLC
Entity type:Organization
Organization Name:COBBLE HILL ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-649-8082
Mailing Address - Street 1:36 E COBBLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1310
Mailing Address - Country:US
Mailing Address - Phone:781-325-3286
Mailing Address - Fax:
Practice Address - Street 1:1182 TROY SCHENECTADY RD STE 201
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-649-8082
Practice Address - Fax:518-649-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262197-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05419961Medicaid