Provider Demographics
NPI:1962780015
Name:MONITORED ANESTHESIA CARE PC
Entity type:Organization
Organization Name:MONITORED ANESTHESIA CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAFULLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-953-3333
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-0550
Mailing Address - Country:US
Mailing Address - Phone:201-953-3333
Mailing Address - Fax:732-440-4314
Practice Address - Street 1:55 S HYDE AVE
Practice Address - Street 2:UNIT #347
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2180
Practice Address - Country:US
Practice Address - Phone:201-953-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03688900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty