Provider Demographics
NPI:1194167320
Name:ENGLEWOOD CLIFFS ANESTHESIA LLC
Entity type:Organization
Organization Name:ENGLEWOOD CLIFFS ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-607-9090
Mailing Address - Street 1:1532 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2128
Mailing Address - Country:US
Mailing Address - Phone:732-607-9090
Mailing Address - Fax:732-607-1160
Practice Address - Street 1:400 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2729
Practice Address - Country:US
Practice Address - Phone:201-227-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04523900305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization