Organization
BREAKWATER ANESTHESIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB BEVILACQUA CRNA (CO-OWNER)
(617) 922-5655
Entity
Organization
Contact information
Practice address
900 CUMMINGS CTR STE 117T, BEVERLY, MA 01915-6183
(617) 922-5655
Mailing address
7 ELWELL ST UNIT 2, GLOUCESTER, MA 01930-2905
(617) 922-5655
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679916142
NPI - PATRICK KEATING
—
01
—
1992048870
NPI - JACOB BEVILACQUA
—
Enumeration date
11/04/2018
Last updated
01/08/2019
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