1407079759 NPI number — NORTH SHORE REHABILITATION ASSOCIATES INC.

Table of content: (NPI 1407079759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407079759 NPI number — NORTH SHORE REHABILITATION ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE REHABILITATION ASSOCIATES INC.
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:
1407079759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 BROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01901-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-593-9090
Provider Business Mailing Address Fax Number:
780-593-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01901-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-593-9090
Provider Business Practice Location Address Fax Number:
780-593-9093
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PYATIGORSKIY
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-593-9093

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9751441 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com