Provider Demographics
NPI:1104053917
Name:ANESTHESIA ASSOCIATES ON THE PALISADES, P.C.
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES ON THE PALISADES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ZUBKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-8088
Mailing Address - Street 1:20-01 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1523
Mailing Address - Country:US
Mailing Address - Phone:201-791-8088
Mailing Address - Fax:201-791-2202
Practice Address - Street 1:20-01 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1523
Practice Address - Country:US
Practice Address - Phone:201-791-8088
Practice Address - Fax:201-791-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239806207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI57809Medicare UPIN