1992364160 NPI number — NOVA LEAP HEALTH MA INC

Table of content: (NPI 1992364160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992364160 NPI number — NOVA LEAP HEALTH MA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA LEAP HEALTH MA 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:
1992364160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 BOSTON TURNPIKE
Provider Second Line Business Mailing Address:
SUITE 308D
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-842-5576
Provider Business Mailing Address Fax Number:
508-842-5575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 BOSTON TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE 308D
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-842-5576
Provider Business Practice Location Address Fax Number:
508-842-5575
Provider Enumeration Date:
06/11/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPIDLE
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
902-223-3865

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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