Provider Demographics
NPI:1851523799
Name:BROOKLYN ANESTHESIA GROUP, PC
Entity type:Organization
Organization Name:BROOKLYN ANESTHESIA GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-369-3080
Mailing Address - Street 1:565 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3519
Mailing Address - Country:US
Mailing Address - Phone:718-369-3080
Mailing Address - Fax:718-369-3271
Practice Address - Street 1:629 W 185TH ST
Practice Address - Street 2:5TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:212-928-0521
Practice Address - Fax:718-369-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty