1285711606 NPI number — DR. BORIS DOV DJERASSI DC

Table of content: DR. BORIS DOV DJERASSI DC (NPI 1285711606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285711606 NPI number — DR. BORIS DOV DJERASSI DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DJERASSI
Provider First Name:
BORIS
Provider Middle Name:
DOV
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DJERASSI
Provider Other First Name:
BORIS
Provider Other Middle Name:
DOV
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285711606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-672-0158
Provider Business Mailing Address Fax Number:
508-730-1223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 BEDFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-677-2222
Provider Business Practice Location Address Fax Number:
508-730-1223
Provider Enumeration Date:
11/01/2006

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: 111N00000X , with the licence number:  1980 , 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: 352327 . This is a "HARVARD PILGRIM - MA. ID#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 667631 . This is a "ACN GROUP US HELATHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36409 . This is a "BLUE CROSS - MA. ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7267-8 . This is a "BLUE CROSS - RI. ID #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 409082 . This is a "BLUE CHIP - RI. ID #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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