1255313375 NPI number — JOSEPH HENRY ALBECK MD

Table of content: RYAN M HOFFMAN D.D.S. (NPI 1861844599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255313375 NPI number — JOSEPH HENRY ALBECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBECK
Provider First Name:
JOSEPH
Provider Middle Name:
HENRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBECK
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
HENRY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD PC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255313375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02468-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-484-1500
Provider Business Mailing Address Fax Number:
617-332-0605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 LEONARD ST
Provider Second Line Business Practice Location Address:
SUIT # 5
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02478-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-484-1500
Provider Business Practice Location Address Fax Number:
617-332-0605
Provider Enumeration Date:
11/15/2005

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: 2084P0800X , with the licence number:  058501 , 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: 0167908 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058501 . This is a "LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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