Provider Demographics
NPI:1669607123
Name:BROOKLYN ANESTHESIA GROUP PC
Entity type:Organization
Organization Name:BROOKLYN ANESTHESIA GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-369-3080
Mailing Address - Street 1:565 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3519
Mailing Address - Country:US
Mailing Address - Phone:718-369-3080
Mailing Address - Fax:
Practice Address - Street 1:234-28 MERRICK BLVD, 2FLR.
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1320
Practice Address - Country:US
Practice Address - Phone:718-369-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty