1619943735 NPI number — PETER JOSEPH SWARTZ PSYD

Table of content: PETER JOSEPH SWARTZ PSYD (NPI 1619943735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619943735 NPI number — PETER JOSEPH SWARTZ PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWARTZ
Provider First Name:
PETER
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1619943735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
W. NEWBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-521-5624
Provider Business Mailing Address Fax Number:
978-463-4962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 CHARLES ST.
Provider Second Line Business Practice Location Address:
SUITE 264 MASSACHUSETTS EYE & EAR INFIRMARY
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-521-5624
Provider Business Practice Location Address Fax Number:
978-463-4962
Provider Enumeration Date:
02/28/2006

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: 103T00000X , with the licence number:  4996 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 4996 , 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: 0520411 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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