Basic Information
| Provider Information | |||||||||
| NPI: | 1720011216 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARDEN STATE ANESTHESIA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 441 | ||||||||
| Address2: | |||||||||
| City: | ORADELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076490441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013451259 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 N BEERS ST | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077331514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HANDLIN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013421205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.