1285639542 NPI number — NEW ENGLAND BRACE COMPANY, INC.

Table of content: (NPI 1285639542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285639542 NPI number — NEW ENGLAND BRACE COMPANY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND BRACE COMPANY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285639542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103-2734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-880-7250
Provider Business Mailing Address Fax Number:
603-668-2468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 AMHERST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-880-7250
Provider Business Practice Location Address Fax Number:
603-668-2468
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GUIMOND
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-668-8360

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1002782 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30011533 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4696 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1200976Y0NH01 . This is a "BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 700383 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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