NPIMap

Organization Active NPI

Wine Anesthesia, LLC

  • Anesthesiology Physician
  • Staten Island, NY
National Provider Identifier
1407984255
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
WINE ANESTHESIA, LLC
Practice address
129 Slosson Ave
Staten Island, NY 10314-2522
Phone
(718) 720-5928
NPI assigned
Mar 2, 2007
Last updated
Apr 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Authorized official

Name
Lawrence Wine, MDNPI 1114925013
Title
President
Phone
(718) 663-9251

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

129 Slosson Ave
Staten Island, NY 10314-2522

Mailing address

PO Box 120223
Staten Island, NY 10312-0223
Phone (718) 663-9251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090323000047 NY Part B Supplier - Clinic/Group Practice 4688769094 Receives reassigned benefits from 10 practitioners
Practice locations: Staten Island, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

150 E 61st St
New York, NY 10065
Phone (212) 644-0002

1441 South Ave
Fl 8
Staten Island, NY 10314
Phone (718) 720-5928

5 Coddington Ave
Staten Island, NY 10306
Phone (718) 351-1350

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1407984255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120223",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103120223",
            "telephone_number": "718-663-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 SLOSSON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103142522",
            "telephone_number": "718-720-5928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINE ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "WINE",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-663-9251",
        "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": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.