1821061193 NPI number — DR PETER E YAFFE PC

Table of content: (NPI 1821061193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821061193 NPI number — DR PETER E YAFFE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR PETER E YAFFE PC
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:
6
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:
1821061193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327D BOSTON POST RD
Provider Second Line Business Mailing Address:
WAYSIDE COUNSELING ASSOCIATES
Provider Business Mailing Address City Name:
SUDBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01776-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-443-4262
Provider Business Mailing Address Fax Number:
978-443-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327D BOSTON POST RD
Provider Second Line Business Practice Location Address:
WAYSIDE COUNSELING ASSOCIATES
Provider Business Practice Location Address City Name:
SUDBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01776-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-443-4262
Provider Business Practice Location Address Fax Number:
978-443-4262
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YAFFE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
ELLIOT
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
978-443-4262

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5619043 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 757593 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: W10369 . This is a "BLUE SHIELD OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011850 . This is a "BEACON HEALTH STRATEGIES" identifier . This identifiers is of the category "OTHER".




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