1265594295 NPI number — MS. HEATHER MARIE BIEDRZYCKI MA

Table of content: MS. HEATHER MARIE BIEDRZYCKI MA (NPI 1265594295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265594295 NPI number — MS. HEATHER MARIE BIEDRZYCKI MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIEDRZYCKI
Provider First Name:
HEATHER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265594295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 WESTBROOK CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-372-5205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 WARREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-452-1736
Provider Business Practice Location Address Fax Number:
978-452-6625
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)