Provider Demographics
NPI:1194948596
Name:GYN ANESTHESIA GROUP LLC
Entity type:Organization
Organization Name:GYN ANESTHESIA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-0522
Mailing Address - Street 1:10 ZABRISKIE ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4905
Mailing Address - Country:US
Mailing Address - Phone:201-567-0522
Mailing Address - Fax:201-567-5955
Practice Address - Street 1:10 ZABRISKIE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4905
Practice Address - Country:US
Practice Address - Phone:201-567-0522
Practice Address - Fax:201-567-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty