1013967389 NPI number — DR. ARTHUR BABABEKOV OD

Table of content: DR. ARTHUR BABABEKOV OD (NPI 1013967389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013967389 NPI number — DR. ARTHUR BABABEKOV OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABABEKOV
Provider First Name:
ARTHUR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1013967389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYNHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02767-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-823-9307
Provider Business Mailing Address Fax Number:
508-484-2008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 SEYON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-891-0136
Provider Business Practice Location Address Fax Number:
508-484-2008
Provider Enumeration Date:
05/10/2006

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: 152W00000X , with the licence number:  4436 , 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: 7950681 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0035583 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-01647 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1814821 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16455 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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