1497156392 NPI number — THE SPIEGEL CENTER

Table of content: (NPI 1497156392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497156392 NPI number — THE SPIEGEL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SPIEGEL CENTER
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:
6
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:
1497156392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 BOYLSTON STREET
Provider Second Line Business Mailing Address:
FRONT
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-566-3223
Provider Business Mailing Address Fax Number:
617-566-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 BOYLSTON STREET
Provider Second Line Business Practice Location Address:
FRONT
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-566-3223
Provider Business Practice Location Address Fax Number:
617-566-3220
Provider Enumeration Date:
09/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SPIEGEL
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
617-566-3223

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 205428 , 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)

  • Identifier: 0112020 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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