1255809018 NPI number — JAIME BERLIN TALKOWSKI PHD MPT

Table of content: JAIME BERLIN TALKOWSKI PHD MPT (NPI 1255809018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255809018 NPI number — JAIME BERLIN TALKOWSKI PHD MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALKOWSKI
Provider First Name:
JAIME
Provider Middle Name:
BERLIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERLIN
Provider Other First Name:
JAIME
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255809018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 WOODPARK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421-7207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-202-0693
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 BEDFORD ST STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02420-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-863-1801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2018

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: 225100000X , with the licence number:  18278 , 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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