Northeastern Anesthesia Institute LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA06129800 Issued in NJ

Legal business name

NORTHEASTERN ANESTHESIA INSTITUTE LLC

Practice address

1373 Broad St
Clifton, NJ 07013-4200

Phone

(201) 342-1205

Fax

(201) 342-1259

NPI assigned

Oct 10, 2016

Last updated

Oct 10, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tomislav Prvulovic, MD

Title

Sole Member

Phone

(201) 342-1205

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1356891717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1373 BROAD ST",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070134200",
            "telephone_number": "201-342-1205",
            "fax_number": "201-342-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1373 BROAD ST",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070134200",
            "telephone_number": "201-342-1205",
            "fax_number": "201-342-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN ANESTHESIA INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "PRVULOVIC",
        "authorized_official_first_name": "TOMISLAV",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "201-342-1205",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06129800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.