1013048180 NPI number — ATLANTIC COAST OPHTHALMOLOGY, P.C.

Table of content: (NPI 1013048180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013048180 NPI number — ATLANTIC COAST OPHTHALMOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC COAST OPHTHALMOLOGY, P.C.
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:
1013048180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 LYNNWAY
Provider Second Line Business Mailing Address:
SUITE 2G
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01902-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-593-3939
Provider Business Mailing Address Fax Number:
781-593-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 LYNNWAY
Provider Second Line Business Practice Location Address:
SUITE 2G
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01902-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-593-3939
Provider Business Practice Location Address Fax Number:
781-593-4449
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-593-3939

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  78232 , 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: 2254201 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2366203 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 470104 . This is a "TUFTS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: AA26124 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 92136 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 968560 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0036754 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 79258 . This is a "UNICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9750771 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J28467 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4081728 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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