1396821427 NPI number — BOSTON IVF, 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 1396821427 NPI number — BOSTON IVF, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON IVF, 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:
6
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:
1396821427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 2ND AVE
Provider Second Line Business Mailing Address:
BOSTON IVF, INC. - LAB
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-434-6400
Provider Business Mailing Address Fax Number:
781-434-6464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 2ND AVE
Provider Second Line Business Practice Location Address:
BOSTON IVF, INC. - LAB
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-434-6400
Provider Business Practice Location Address Fax Number:
781-434-6464
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARKIN
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOR OF BUSINESS
Authorized Official Telephone Number:
781-434-6500

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  2517 , 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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