1184068876 NPI number — MR. ROMAN WASYL GUSZTAK M.D.

Table of content: MR. ROMAN WASYL GUSZTAK M.D. (NPI 1184068876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184068876 NPI number — MR. ROMAN WASYL GUSZTAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUSZTAK
Provider First Name:
ROMAN
Provider Middle Name:
WASYL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1184068876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/27/2014
NPI Reactivation Date:
05/06/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LONGWOOD AVENUE, BOSTON CHILDREN'S HOSPITAL
Provider Second Line Business Mailing Address:
DEPARTMENT OF ANESTHESIOLOGY PERIOPERATIVE AND PAIN MED
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-355-8173
Provider Business Mailing Address Fax Number:
617-730-0894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LONGWOOD AVENUE, BOSTON CHILDREN'S HOSPITAL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIOLOGY PERIOPERATIVE AND PAIN MED
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-355-8173
Provider Business Practice Location Address Fax Number:
617-730-0894
Provider Enumeration Date:
04/24/2013

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: 207L00000X , with the licence number:  110562 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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