1689817728 NPI number — CYNTHIA A. VELLA N.P. LLC

Table of content: (NPI 1689817728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689817728 NPI number — CYNTHIA A. VELLA N.P. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA A. VELLA N.P. 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:
NEW ENGLAND MOTHERS FIRST
Provider Other Organization Name Type Code:
3
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:
1689817728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 483
Provider Second Line Business Mailing Address:
28 OCEAN AVENUE
Provider Business Mailing Address City Name:
CATAUMET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02534-0483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-566-1155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BRIDGEWATER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02379-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-566-1155
Provider Business Practice Location Address Fax Number:
508-563-3602
Provider Enumeration Date:
04/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VELLA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
508-566-1155

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  169978 , 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: AA145287 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M19209 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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