Provider Demographics
NPI:1962560607
Name:MOBILE ANESTHESIA ASSOC PC
Entity type:Organization
Organization Name:MOBILE ANESTHESIA ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:ZALMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-591-6604
Mailing Address - Street 1:71 19 PARK AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4136
Mailing Address - Country:US
Mailing Address - Phone:718-591-6604
Mailing Address - Fax:718-591-7105
Practice Address - Street 1:7119 PARK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4136
Practice Address - Country:US
Practice Address - Phone:718-591-6604
Practice Address - Fax:718-591-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158429207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61298Medicare UPIN
NYW20041Medicare PIN