1710985353 NPI number — METABOLIC SOLUTIONS LLC

Table of content: (NPI 1710985353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710985353 NPI number — METABOLIC SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METABOLIC SOLUTIONS 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:
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:
1710985353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 AMHERST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03063-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-598-6960
Provider Business Mailing Address Fax Number:
603-598-6973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 AMHERST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-598-6960
Provider Business Practice Location Address Fax Number:
603-598-6973
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FAKHOURY
Authorized Official First Name:
ADNAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AO
Authorized Official Telephone Number:
603-598-6960

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  02731 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 30D0970292 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 148922709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164498454 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89450201 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2386565 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151870000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30802448 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00181 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02517655 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200454380A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001225 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806879100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 831608202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009931755 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003119220 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200050790A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164119 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157047502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: LB460NH , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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