1891388476 NPI number — TONGUE AND LIP-TIE CENTER OF NEW ENGLAND

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 1891388476 NPI number — TONGUE AND LIP-TIE CENTER OF NEW ENGLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TONGUE AND LIP-TIE CENTER OF NEW ENGLAND
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:
1891388476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 GAR HWY STE 3A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02777-3935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-720-2121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 GAR HWY STE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02777-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-720-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LAVOIE
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
508-720-2121

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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