Provider Demographics
NPI:1447457049
Name:DOV PHIL ANESTHESIOLOGY GROUP, PLLC
Entity type:Organization
Organization Name:DOV PHIL ANESTHESIOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOBRUTSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-236-1056
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 E 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7203
Practice Address - Country:US
Practice Address - Phone:718-236-1056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX081Medicare ID - Type Unspecified