1558308205 NPI number — DR. NEIL D KOBROSKY MD

Table of content: DR. NEIL D KOBROSKY MD (NPI 1558308205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558308205 NPI number — DR. NEIL D KOBROSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOBROSKY
Provider First Name:
NEIL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1558308205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 EASTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLOUCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-281-6890
Provider Business Mailing Address Fax Number:
978-281-0932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
298 WASHINGTON ST
Provider Second Line Business Practice Location Address:
ADDISON GILBERT HOSPITAL
Provider Business Practice Location Address City Name:
GLOUCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-283-4000
Provider Business Practice Location Address Fax Number:
978-282-0663
Provider Enumeration Date:
06/01/2006

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: 207RE0101X , with the licence number:  54501 , 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: 51998 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61683 . This is a "PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 31979 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3050122 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5015917 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 713905 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110029028 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".




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