Provider Demographics
NPI:1962576322
Name:MEADOWLANDS PINNACLE ANESTHESIA
Entity type:Organization
Organization Name:MEADOWLANDS PINNACLE ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-840-9688
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-0036
Mailing Address - Country:US
Mailing Address - Phone:201-840-9490
Mailing Address - Fax:201-840-9510
Practice Address - Street 1:581 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2030
Practice Address - Country:US
Practice Address - Phone:201-840-9490
Practice Address - Fax:201-840-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148005Medicare ID - Type Unspecified