Provider Demographics
NPI:1447433958
Name:RIVERSIDE ANESTHESIA
Entity type:Organization
Organization Name:RIVERSIDE ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-877-3778
Mailing Address - Street 1:263 W END AVE
Mailing Address - Street 2:STE 22B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2612
Mailing Address - Country:US
Mailing Address - Phone:212-877-3778
Mailing Address - Fax:
Practice Address - Street 1:2500 RTE 347
Practice Address - Street 2:BLDG 24C
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:212-877-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty