1801884721 NPI number — WESTERN MASSACHUSETTS PODIATRY ASSOCIATES, P.C.

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 1801884721 NPI number — WESTERN MASSACHUSETTS PODIATRY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MASSACHUSETTS PODIATRY ASSOCIATES, P.C.
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:
1801884721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
EAST LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-525-4373
Provider Business Mailing Address Fax Number:
413-525-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
264 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
EAST LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01028-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-525-4373
Provider Business Practice Location Address Fax Number:
413-525-9098
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CWASS
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
413-525-4373

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2189 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 2038 , 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)





Copyright © 2007-2025 www.npivalidator.com