1114052784 NPI number — ROBERT H OSOFSKY MD PC

Table of content: (NPI 1114052784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114052784 NPI number — ROBERT H OSOFSKY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT H OSOFSKY MD PC
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:
1114052784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 CAREW ST
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-734-4918
Provider Business Mailing Address Fax Number:
413-734-4919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 CAREW ST.
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-734-4918
Provider Business Practice Location Address Fax Number:
413-734-4919
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSOFSKY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
413-734-4918

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  39759 , 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: 725030 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2045206 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: N51652 . This is a "BLUE CROSS BLUE SHILED MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 15134 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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