Provider Demographics
NPI:1548312143
Name:ANESTHESIOLOGY ASSOCIATES OF NEW JERSEY, P.A.
Entity type:Organization
Organization Name:ANESTHESIOLOGY ASSOCIATES OF NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:VENKATARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-4000
Mailing Address - Street 1:1060 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3638
Mailing Address - Country:US
Mailing Address - Phone:973-779-7354
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-365-4000
Practice Address - Fax:973-779-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68507207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7979207Medicaid
NJ028625Medicare ID - Type Unspecified
NJ7979207Medicaid