Northeast Ambulatory Anesthesia LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

NORTHEAST AMBULATORY ANESTHESIA LLC

Practice address

4920 Main St
Bridgeport, CT 06606-1300

Phone

(203) 583-8906

NPI assigned

Mar 19, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Wagner, MD

Title

Manager

Phone

(203) 467-2474

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1194119982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 HIGH STREET",
            "city": "EAST HAVEN",
            "state": "CT",
            "postal_code": "06512",
            "telephone_number": "203-467-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061300",
            "telephone_number": "203-583-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST AMBULATORY ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-19",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "203-467-2474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Anesthesiology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.