Provider Demographics
NPI:1063415990
Name:ADVANCED AMBULATORY ANESTHESIA, LLC
Entity type:Organization
Organization Name:ADVANCED AMBULATORY ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:REUVENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-229-0559
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-0343
Mailing Address - Country:US
Mailing Address - Phone:862-229-0559
Mailing Address - Fax:
Practice Address - Street 1:1176 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5054
Practice Address - Country:US
Practice Address - Phone:862-229-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8038309Medicaid
NJ033805Medicare ID - Type Unspecified