Basic Information
| Provider Information | |||||||||
| NPI: | 1629074224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA CARE GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 WALT WHITMAN RD STE 300 | ||||||||
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| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117474300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 88 MCGREGOR ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154135229 | ||||||||
| FaxNumber: | 6036472453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZIELINSKI | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5169453028 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 30211277 | 05 | NH | MEDICAID |