1528003621 NPI number — JOSLIN CLINIC INC

Table of content: (NPI 1528003621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528003621 NPI number — JOSLIN CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSLIN CLINIC 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:
1528003621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JOSLIN PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-309-2400
Provider Business Mailing Address Fax Number:
617-309-2574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JOSLIN PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-2501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEHTA
Authorized Official First Name:
SANJEEV
Authorized Official Middle Name:
N
Authorized Official Title or Position:
SVP, CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
617-309-2470

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  4S33 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9784373 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH7221 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".