1952521999 NPI number — ESSEX CARDIOLOGY ASSOCIATES, INC

Table of content: (NPI 1952521999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952521999 NPI number — ESSEX CARDIOLOGY ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESSEX CARDIOLOGY ASSOCIATES, 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:
1952521999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 HERRICK ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-927-8400
Provider Business Mailing Address Fax Number:
978-922-1452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 HERRICK ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-927-8400
Provider Business Practice Location Address Fax Number:
978-922-1452
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLEARY
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
X
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-927-8400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 0008246 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0063094 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 661 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600476 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9745483 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M14172 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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