1578668588 NPI number — DR. JEAN T ROSOWSKI AUD

Table of content: DR. JEAN T ROSOWSKI AUD (NPI 1578668588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578668588 NPI number — DR. JEAN T ROSOWSKI AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSOWSKI
Provider First Name:
JEAN
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

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:
1578668588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 CONCORD AVE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-484-8700
Provider Business Mailing Address Fax Number:
617-484-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 CONCORD AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-484-8700
Provider Business Practice Location Address Fax Number:
617-484-3043
Provider Enumeration Date:
09/14/2006

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: 231H00000X , with the licence number:  174 , 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: 797641 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5102359 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA143249 . This is a "HARVARD PILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4500070 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AD0062 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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