1164662219 NPI number — DIANE ROBERTS STOLER EDD, LLC

Table of content: (NPI 1164662219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164662219 NPI number — DIANE ROBERTS STOLER EDD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIANE ROBERTS STOLER EDD, LLC
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:
1164662219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01833-0148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-352-6349
Provider Business Mailing Address Fax Number:
978-352-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 WASHINGTON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOXFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01921-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-352-6349
Provider Business Practice Location Address Fax Number:
978-352-2835
Provider Enumeration Date:
03/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STOLER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
978-352-6349

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  2229 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TE1100X , with the licence number: 2229 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: 2229 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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