1346387560 NPI number — HERITAGE PARK ORTHOPEDICS

Table of content: (NPI 1346387560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346387560 NPI number — HERITAGE PARK ORTHOPEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE PARK ORTHOPEDICS
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:
1346387560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 MERRIMACK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01854-3571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-452-9914
Provider Business Mailing Address Fax Number:
978-453-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 MERRIMACK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01854-3571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-452-9914
Provider Business Practice Location Address Fax Number:
978-453-0069
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONFORTI
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-452-9914

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35426 , 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: 9769692 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com