1881684934 NPI number — NEW DIMENSIONS IN HEALTH, INC.

Table of content: ABIGAIL ELIZABETH RUSSI MD (NPI 1417303314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881684934 NPI number — NEW DIMENSIONS IN HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DIMENSIONS IN HEALTH, 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:
6
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:
1881684934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
653 SUMMER ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02210-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-269-6262
Provider Business Mailing Address Fax Number:
617-269-1068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 SUMMER ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02210-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-269-6262
Provider Business Practice Location Address Fax Number:
617-269-1068
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERSHBERG
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR / OWNER
Authorized Official Telephone Number:
617-269-6262

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8211 . This is a "NEIGHBORHOOD HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y65611 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 718592 . This is a "TUFTS HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10230200 . This is a "ACS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4598099 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 603413 . This is a "HARVARD PILGRIM HC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6440025 . This is a "UNITED HC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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