1104613918 NPI number — JADE IWASAKA-NEDER MD, MPH

Table of content: JADE IWASAKA-NEDER MD, MPH (NPI 1104613918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104613918 NPI number — JADE IWASAKA-NEDER MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IWASAKA-NEDER
Provider First Name:
JADE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IWASAKA NEDER STAVROPULOS
Provider Other First Name:
JADE
Provider Other Middle Name:
BEATRIZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104613918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
266 WAVERLEY ST APT 349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-7622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-424-7886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-6358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-383-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2025

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)





Copyright © 2007-2025 www.npivalidator.com