1700191814 NPI number — CHILDRENS HOSPITAL BOSTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700191814 NPI number — CHILDRENS HOSPITAL BOSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HOSPITAL BOSTON
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:
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:
1700191814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 VFW PKWY
Provider Second Line Business Mailing Address:
HANCOCK VILLAGE ,298 INDEPENDENCE DRIVE,CHESTNUT HILL
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-355-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SOUL
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT PROFESSOR OF NEUROLOGY
Authorized Official Telephone Number:
617-355-8994

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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