1902864150 NPI number — BOSTON BRACE INTERNATIONAL INC.

Table of content: (NPI 1902864150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902864150 NPI number — BOSTON BRACE INTERNATIONAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON BRACE INTERNATIONAL 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:
BOSTON ORTHOTICS & PROSTHETICS
Provider Other Organization Name Type Code:
3
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:
1902864150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 SHUMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOUGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02072-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-588-6060
Provider Business Mailing Address Fax Number:
508-559-2750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-9399
Provider Business Practice Location Address Fax Number:
267-787-5624
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISSEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
508-588-6060

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4532848 . This is a "AETNA NON HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203318 . This is a "BLUE CROSS KHPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3537901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6321880002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006759 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60008DM . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".




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