1841360716 NPI number — CENTER FOR BLISTERING DISEASES, INC

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 1841360716 NPI number — CENTER FOR BLISTERING DISEASES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR BLISTERING DISEASES, INC
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:
1841360716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
697 CAMBRIDGE ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-2897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-562-1040
Provider Business Mailing Address Fax Number:
617-562-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
697 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-562-1040
Provider Business Practice Location Address Fax Number:
617-562-1047
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
RAZZAQUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-562-1040

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 690849 . This is a "TUFTS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001620 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: CQ80 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59699 . This is a "FALLON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CQ80 . This is a "HPHC FIRST SENIORITY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3051578 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA7122 . This is a "RAILROAD MEDICARE PALMETO" identifier . This identifiers is of the category "OTHER".
  • Identifier: M17819 . This is a "BCBS RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: M17819 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".




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