1558551069 NPI number — NEUROLOGY PARTNERS PC

Table of content: (NPI 1558551069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558551069 NPI number — NEUROLOGY PARTNERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY PARTNERS PC
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:
1558551069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-431-2026
Provider Business Mailing Address Fax Number:
508-431-2296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-431-2026
Provider Business Practice Location Address Fax Number:
508-431-2296
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TETREAULT
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
401-742-5965

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  150014 , 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: 1780642611 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780642611 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3187837 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649703547 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649703547 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568975969 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568975969 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124090691 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124090691 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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