Provider Demographics
NPI:1053514034
Name:ADVANCED ANESTHESIA CARE MD PC
Entity type:Organization
Organization Name:ADVANCED ANESTHESIA CARE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-753-0913
Mailing Address - Street 1:1037 US HIGHWAY 46
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2451
Mailing Address - Country:US
Mailing Address - Phone:973-471-8852
Mailing Address - Fax:973-471-4685
Practice Address - Street 1:1037 US HIGHWAY 46
Practice Address - Street 2:SUITE 103
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2451
Practice Address - Country:US
Practice Address - Phone:973-471-8852
Practice Address - Fax:973-471-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03433700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11063Medicare PIN