1730752288 NPI number — MATTHEW J PIZZI BCBA

Table of content: MATTHEW J PIZZI BCBA (NPI 1730752288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730752288 NPI number — MATTHEW J PIZZI BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIZZI
Provider First Name:
MATTHEW
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
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:
1730752288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOFFSTOWN
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03045-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-633-7979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MAIN DUNSTABLE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-959-4222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2021

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: 103K00000X , with the licence number:  1-19-39237 , 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)