1700884798 NPI number — EASTERN PULMONARY SERVICES, INC.

Table of content: (NPI 1700884798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700884798 NPI number — EASTERN PULMONARY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PULMONARY SERVICES, INC.
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:
1700884798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
277 SOUTH ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALPOLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02081-2731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-400-0044
Provider Business Mailing Address Fax Number:
866-203-5459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 SOUTH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALPOLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02081-2731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-400-0044
Provider Business Practice Location Address Fax Number:
866-203-5459
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RABINOVSKY
Authorized Official First Name:
GIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-259-6944

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 801507 . This is a "TUFTS HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 347154 . This is a "BC/BS OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1534343 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 701705 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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