1720012180 NPI number — HELEN E GRUBER PHD

Table of content: HELEN E GRUBER PHD (NPI 1720012180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720012180 NPI number — HELEN E GRUBER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBER
Provider First Name:
HELEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1720012180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COHASSET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02025-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-383-9780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
84 JERUSALEM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COHASSET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02025-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-383-9780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

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: 103G00000X , with the licence number:  6074 , 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: 0521086 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W04878 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 680009813 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com