1790831238 NPI number — BOSTON BRACE INTERNATIONAL INC.

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 1790831238 NPI number — BOSTON BRACE INTERNATIONAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON BRACE INTERNATIONAL 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:
BOSTON ORTHOTICS AND PROSTHETICS
Provider Other Organization Name Type Code:
3
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:
1790831238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 SHUMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOUGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02072-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-588-6060
Provider Business Mailing Address Fax Number:
508-559-2750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 HOPE AVE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02453-2721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-786-2900
Provider Business Practice Location Address Fax Number:
781-373-9527
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISSEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
508-588-6060

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 360254 . This is a "BCBS OF MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800081 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 981339 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1537474 . This is a "MASSHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 830901 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 887817 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009270 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701124 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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