Provider Demographics
NPI:1649549627
Name:NORTHEAST ANESTHESIA AND PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:NORTHEAST ANESTHESIA AND PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-562-0294
Mailing Address - Street 1:54 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3514
Mailing Address - Country:US
Mailing Address - Phone:201-871-4000
Mailing Address - Fax:201-568-6850
Practice Address - Street 1:54 S DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3514
Practice Address - Country:US
Practice Address - Phone:201-871-4000
Practice Address - Fax:201-568-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08595100207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty