1508816042 NPI number — SKIN & LASER SURGERY CENTER OF NEW ENGLAND

Table of content: (NPI 1508816042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508816042 NPI number — SKIN & LASER SURGERY CENTER OF NEW ENGLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKIN & LASER SURGERY CENTER OF NEW ENGLAND
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:
1508816042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 ALLDS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-4745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-886-5506
Provider Business Mailing Address Fax Number:
603-594-2585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 COURTHOUSE LN
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-453-5559
Provider Business Practice Location Address Fax Number:
978-453-4459
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHATRI
Authorized Official First Name:
KHALIL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-453-5559

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0082924 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9427 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CL6494 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 715100 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M13479 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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