1427614569 NPI number — GALLIE A JOSEPH

Table of content: GALLIE A JOSEPH (NPI 1427614569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427614569 NPI number — GALLIE A JOSEPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
GALLIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1427614569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 S BEDFORD ST STE 400W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01803-5177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CEDAR HILL ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-880-0097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2019

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106S00000X . This is a "ABA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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