Provider Demographics
NPI:1871524033
Name:JERSEY ELITE ANESTHESIA GROUP, LLC
Entity type:Organization
Organization Name:JERSEY ELITE ANESTHESIA GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-945-2481
Mailing Address - Street 1:PO BOX 51045
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5145
Mailing Address - Country:US
Mailing Address - Phone:201-945-2481
Mailing Address - Fax:201-943-8105
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-945-2481
Practice Address - Fax:201-943-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0078727Medicaid
NJ0078727Medicaid