1447388640 NPI number — MR. JEFFREY R TONELLO OPA-C, ATC

Table of content: MR. JEFFREY R TONELLO OPA-C, ATC (NPI 1447388640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447388640 NPI number — MR. JEFFREY R TONELLO OPA-C, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONELLO
Provider First Name:
JEFFREY
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OPA-C, ATC
Provider Gender Code:
M

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:
1447388640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1516
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGAMORE BEACH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02562-1516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-889-0880
Provider Business Mailing Address Fax Number:
508-888-3145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 HARRISON AVE
Provider Second Line Business Practice Location Address:
YAWKEY ACC 3 ORTHOPAEDICS
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-414-2598
Provider Business Practice Location Address Fax Number:
617-414-2556
Provider Enumeration Date:
03/01/2007

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: 2255A2300X , with the licence number:  AH-51 , 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: AH-51 . This is a "ALLIED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com