Organization
NORTHEAST AMBULATORY ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WAGNER MD (MANAGER)
(203) 467-2474
Entity
Organization
Contact information
Practice address
4920 MAIN ST, BRIDGEPORT, CT 06606-1300
(203) 583-8906
Mailing address
65 HIGH STREET, EAST HAVEN, CT 06512
(203) 467-2472
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
03/19/2015
Last updated
03/19/2015
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