1568469005 NPI number — DR. MICHAEL ETHAN CHARTOFF D.C.

Table of content: (NPI 1740084177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568469005 NPI number — DR. MICHAEL ETHAN CHARTOFF D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARTOFF
Provider First Name:
MICHAEL
Provider Middle Name:
ETHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1568469005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 BOYLSTON ST
Provider Second Line Business Mailing Address:
SUITE 41
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02116-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-451-1111
Provider Business Mailing Address Fax Number:
617-451-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 41
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02116-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-451-1111
Provider Business Practice Location Address Fax Number:
617-451-1122
Provider Enumeration Date:
06/30/2005

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: 111N00000X , with the licence number:  2236 , 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: 2691716 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 794755 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 21224282786-01 . This is a "BEECH ST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P3197246 . This is a "OXFORD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 26133 . This is a "FALLEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 350446 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36585 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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