Provider Demographics
NPI:1992194864
Name:AMERICAN ANESTHESIA ASSOCIATE P C
Entity type:Organization
Organization Name:AMERICAN ANESTHESIA ASSOCIATE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-200-0723
Mailing Address - Street 1:2512 148TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1433
Mailing Address - Country:US
Mailing Address - Phone:718-200-0723
Mailing Address - Fax:516-706-6026
Practice Address - Street 1:2512 148TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1433
Practice Address - Country:US
Practice Address - Phone:718-219-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246186207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02584614Medicaid