1275852097 NPI number — INSTITUTE FOR SEXUAL WELLNESS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275852097 NPI number — INSTITUTE FOR SEXUAL WELLNESS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR SEXUAL WELLNESS, INC
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:
1275852097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1233 HANCOCK ST
Provider Second Line Business Mailing Address:
REAR
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-4342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-479-4501
Provider Business Mailing Address Fax Number:
617-479-8109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1233 HANCOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-479-4501
Provider Business Practice Location Address Fax Number:
617-479-8109
Provider Enumeration Date:
05/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SORRENTINO
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
617-479-4501

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X , with the licence number:  207842 , 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)





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