1467594887 NPI number — NEW ENGLAND RADIOLOGY & LAB SERVICES, P.C.

Table of content: (NPI 1467594887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467594887 NPI number — NEW ENGLAND RADIOLOGY & LAB SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND RADIOLOGY & LAB SERVICES, P.C.
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:
1467594887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 JOHN A CUMMINGS WAY
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-3224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-767-2036
Provider Business Mailing Address Fax Number:
401-767-2037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 JOHN A CUMMINGS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-767-2036
Provider Business Practice Location Address Fax Number:
401-767-2037
Provider Enumeration Date:
02/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELKADI
Authorized Official First Name:
HISHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-767-2036

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1255187 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1467594 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32489 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AA107795 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 662250 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7627949 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".