1558690222 NPI number — MR. JEFFREY ROBERT MURPHY OPTICIAN-HEARING AID

Table of content: MR. JEFFREY ROBERT MURPHY OPTICIAN-HEARING AID (NPI 1558690222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558690222 NPI number — MR. JEFFREY ROBERT MURPHY OPTICIAN-HEARING AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURPHY
Provider First Name:
JEFFREY
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OPTICIAN-HEARING AID
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:
1558690222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 311
Provider Second Line Business Mailing Address:
610 WASHINGTON ST.
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02359-0484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-826-4656
Provider Business Mailing Address Fax Number:
781-826-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 WASHINGTON ST
Provider Second Line Business Practice Location Address:
PEMBROKE EYE & EAR CARE CENTER
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02359-0484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-826-4656
Provider Business Practice Location Address Fax Number:
781-826-6100
Provider Enumeration Date:
12/09/2009

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: 332S00000X , with the licence number:  #134 , 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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