1720103864 NPI number — NASHUA PODIATRY ASSOCIATES, PLLC

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 1720103864 NPI number — NASHUA PODIATRY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASHUA PODIATRY ASSOCIATES, PLLC
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:
1720103864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 KINSLEY ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-880-9177
Provider Business Mailing Address Fax Number:
603-880-9672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 KINSLEY ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-880-9177
Provider Business Practice Location Address Fax Number:
603-880-9672
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOSOFSKY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ROSS
Authorized Official Title or Position:
DIRECT OWNER
Authorized Official Telephone Number:
603-880-9177

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  NH166 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30364139 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30364154 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30364153 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC3586 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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