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Organization
WINE ANESTHESIA, LLC
Active
Organization
WINE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE WINE MD (PRESIDENT)
(718) 663-9251
Entity
Organization
Contact information
Practice address
129 SLOSSON AVE, STATEN ISLAND, NY 10314-2522
(718) 720-5928
Mailing address
PO BOX 120223, STATEN ISLAND, NY 10312-0223
(718) 663-9251
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
03/02/2007
Last updated
04/23/2021
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