Provider Demographics
NPI:1871696716
Name:PRIVATE ANESTHESIA CONSULTANT PC
Entity type:Organization
Organization Name:PRIVATE ANESTHESIA CONSULTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PISKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-8814
Mailing Address - Street 1:14 WHITEWOOD ROAD
Mailing Address - Street 2:PRIVATE ANESTHESIA CONSULTANT, PC
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-567-8814
Mailing Address - Fax:
Practice Address - Street 1:2647 CONEY ISLAND AVE FL 1
Practice Address - Street 2:PRIVATE ANESTHESIA CONSULTANT PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5502
Practice Address - Country:US
Practice Address - Phone:718-382-0500
Practice Address - Fax:718-382-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCW501Medicare ID - Type Unspecified