Provider Demographics
NPI:1285606616
Name:BROOKLYN KINGS HIGHWAY ANESTHESIOLOGISTS, LLP
Entity type:Organization
Organization Name:BROOKLYN KINGS HIGHWAY ANESTHESIOLOGISTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF ANESTHESIA
Authorized Official - Prefix:DR
Authorized Official - First Name:ESWAR
Authorized Official - Middle Name:DUTT
Authorized Official - Last Name:PILLALAMARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-951-3072
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:BETH ISRAEL MEDICAL CENTER/KINGS HIGHWAY DIVISION
Practice Address - Street 2:3201 KINGS HIGHWAY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-951-3072
Practice Address - Fax:718-951-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01814488Medicaid
CN1751Medicare PIN
NYWAA252Medicare PIN
NY01814488Medicaid
NYW1L671Medicare ID - Type UnspecifiedGROUP I.D. #
NYW1L673Medicare ID - Type UnspecifiedGROUP I.D. #