Basic Information
| Provider Information | |||||||||
| NPI: | 1225267354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPIRE AMBULATORY ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WESTCHESTER AVE | ||||||||
| Address2: | S614 | ||||||||
| City: | RYE BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105731354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144285454 | ||||||||
| FaxNumber: | 9144285460 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WESTCHESTER AVE | ||||||||
| Address2: | S614 | ||||||||
| City: | RYE BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105731354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144285454 | ||||||||
| FaxNumber: | 9144285460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2009 | ||||||||
| LastUpdateDate: | 07/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | BETH | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9144285454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.