1770641425 NPI number — BRUCE TOFIAS

Table of content: (NPI 1770641425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770641425 NPI number — BRUCE TOFIAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE TOFIAS
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:
1770641425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02462-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-964-1840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-964-1840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOFIAS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
BRUCE TOFIAS
Authorized Official Telephone Number:
617-964-1840

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0172197 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047534 TUFTS . This is a "BRUCE TOFIAS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 057337 TUFTS . This is a "JEAN R. PHALEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3024512 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B33656 BLUE CROSS . This is a "BRUCE TOFIAS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 693126 HARVARD PILGR . This is a "JEAN R. PHALEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19156 HARVARD PIGLRI . This is a "BRUCE TOFIAS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J06766 BLUE CROSS . This is a "JEAN R PHALEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18085 BLUECROSS . This is a "GROUP NO TOFIAS & PHALEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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