1720024268 NPI number — BROOKLINE NEWTON WHOLE HEALTH CENTER

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 1720024268 NPI number — BROOKLINE NEWTON WHOLE HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLINE NEWTON WHOLE HEALTH CENTER
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:
1720024268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 320258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ROXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02132-0003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-413-8362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 CENTRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-413-8362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WU
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-413-8362

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2710 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 3064 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1405 , 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: 35472 . This is a "DEBORAH WU HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39428 . This is a "BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3830317 . This is a "LYDIE COLEMAN AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2490916 . This is a "DEBORAH WU AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 31221 . This is a "LYDIE COLEMAN HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44-00391 . This is a "DEBORAH WU UNITED HC/ACN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 668803 . This is a "LYDIE COLEMAN UNITED HC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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