1366420101 NPI number — VEIN AND AESTHETIC CENTER OF BOSTON

Table of content: (NPI 1366420101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366420101 NPI number — VEIN AND AESTHETIC CENTER OF BOSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEIN AND AESTHETIC CENTER OF BOSTON
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:
1366420101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 MAIN ST
Provider Second Line Business Mailing Address:
STE. 670
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-754-3566
Provider Business Mailing Address Fax Number:
508-798-8012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 ELM ST
Provider Second Line Business Practice Location Address:
STE. 205
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-4530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-251-0029
Provider Business Practice Location Address Fax Number:
781-251-0229
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-251-0029

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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