Provider Demographics
NPI:1538616487
Name:WESTCHESTER AMBULATORY ANESTHESIA, PLLC
Entity type:Organization
Organization Name:WESTCHESTER AMBULATORY ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-844-2864
Mailing Address - Street 1:16 S BEDFORD RD
Mailing Address - Street 2:SUITE 3W
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3464
Mailing Address - Country:US
Mailing Address - Phone:914-844-2864
Mailing Address - Fax:
Practice Address - Street 1:16 S BEDFORD RD
Practice Address - Street 2:SUITE 3W
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3464
Practice Address - Country:US
Practice Address - Phone:914-844-2864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1439052207L00000X, 207LP2900X, 207LP3000X
NY193448207LP2900X, 207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty