1780660753 NPI number — DR. DEBRA SUE POSKANZER MD

Table of content: DR. DEBRA SUE POSKANZER MD (NPI 1780660753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780660753 NPI number — DR. DEBRA SUE POSKANZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POSKANZER
Provider First Name:
DEBRA
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1780660753
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:
121 ANDREW 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:
02461-2144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-558-1327
Provider Business Mailing Address Fax Number:
978-428-8952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 REHABILITATION WAY
Provider Second Line Business Practice Location Address:
HEALTHSOUTH NEW ENGLAND REHABILITATION HOSPITAL
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-935-5050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005

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: 208100000X , with the licence number:  60002 , 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: 3081478 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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