1669626099 NPI number — NORTH SHORE SPINE & REHAB

Table of content: DIANE DORTICOS (NPI 1912564436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669626099 NPI number — NORTH SHORE SPINE & REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE SPINE & REHAB
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:
6
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:
1669626099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CUMMINGS PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-938-9400
Provider Business Mailing Address Fax Number:
781-938-9323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CUMMINGS PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-938-9400
Provider Business Practice Location Address Fax Number:
781-938-9323
Provider Enumeration Date:
11/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PENDOLINO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
781-938-9400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2611483 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39891 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1697021 . This is a "MASSHEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA7544 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 460083 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36576 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: TAX ID . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com