1679582175 NPI number — PINNACLE REHABILITATION NETWORK, LLC

Table of content: MELISSA ORTIZ FNP (NPI 1386197036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679582175 NPI number — PINNACLE REHABILITATION NETWORK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE REHABILITATION NETWORK, LLC
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:
1679582175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 NEWTON RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
PLAISTOW
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03865-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-388-7272
Provider Business Mailing Address Fax Number:
978-388-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 WOOD RD STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-535-6053
Provider Business Practice Location Address Fax Number:
781-535-6056
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COSTA NATARIO
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-388-7272

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  23 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110074251A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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