1184915803 NPI number — JACK CLEMENT NAGGAR M.D.

Table of content: JACK CLEMENT NAGGAR M.D. (NPI 1184915803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184915803 NPI number — JACK CLEMENT NAGGAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGGAR
Provider First Name:
JACK
Provider Middle Name:
CLEMENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1184915803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKLINE PL STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-307-4400
Provider Business Mailing Address Fax Number:
857-307-4414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 CENTRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02458-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-796-7170
Provider Business Practice Location Address Fax Number:
617-796-7171
Provider Enumeration Date:
04/28/2011

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: 207R00000X , with the licence number:  270115 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 262268 , 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)





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