1528060118 NPI number — MR. JOSEPH S O CONNOR PT SCS

Table of content: MR. JOSEPH S O CONNOR PT SCS (NPI 1528060118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528060118 NPI number — MR. JOSEPH S O CONNOR PT SCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O CONNOR
Provider First Name:
JOSEPH
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT SCS
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:
1528060118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MARKET ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01901-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-592-0540
Provider Business Mailing Address Fax Number:
781-592-0989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 CROSS ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-1670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-538-7370
Provider Business Practice Location Address Fax Number:
978-538-7372
Provider Enumeration Date:
08/12/2005

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: 2251S0007X , with the licence number:  6761 , 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: 001270 . This is a "NEIGHBORHOOD HLTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 540790 . This is a "CIGNA HEALTH SOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 766575 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2049990 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626117 . This is a "HCHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y61243 . This is a "BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64 00088 . This is a "UNITED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0365106 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2153514 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 612043 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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