1114155942 NPI number — NEW ENGLAND SPINE CENTER, INC.

Table of content: (NPI 1114155942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114155942 NPI number — NEW ENGLAND SPINE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND SPINE CENTER, 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:
1114155942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 HAMPDEN STREET 3RD FLOOR
Provider Second Line Business Mailing Address:
NEW ENGLAND SPINE CENTER, INC.
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-733-1777
Provider Business Mailing Address Fax Number:
413-733-1771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 HAMPDEN STREET 3RD FLOOR
Provider Second Line Business Practice Location Address:
NEW ENGLAND SPINE CENTER, INC.
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-1777
Provider Business Practice Location Address Fax Number:
413-733-1771
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BETANCUR
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
413-733-1777

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2358 , 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: 1699971 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y45368 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36695 . This is a "BC OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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