1689987257 NPI number — JEAN RICHARD DESIR

Table of content: JEAN RICHARD DESIR (NPI 1689987257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689987257 NPI number — JEAN RICHARD DESIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESIR
Provider First Name:
JEAN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1689987257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3222 ARBOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-6010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-275-9115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608-1194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-756-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2010

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: 1041C0700X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95273201 . This is a "NETWORK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1487863494 . This is a "MMIS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1894196 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1081860 . This is a "FALLON/BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1894196 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com