Provider Demographics
NPI:1336146893
Name:GREGORY ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:GREGORY ANESTHESIA SERVICES LLC
Other - Org Name:GREGORY ANESTHESIA SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-795-0205
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:FL 5TH
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-795-0205
Mailing Address - Fax:201-795-0737
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:FL 5TH
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-795-0205
Practice Address - Fax:201-795-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X, 367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7995008Medicaid
NJ027810NBQMedicare UPIN