1942356449 NPI number — RUSSELL & JANE FRADKIN LLC

Table of content: (NPI 1942356449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942356449 NPI number — RUSSELL & JANE FRADKIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL & JANE FRADKIN LLC
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:
1942356449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 PROVIDENCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITINSVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01588-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-234-6681
Provider Business Mailing Address Fax Number:
508-234-6507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITINSVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01588-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-234-6681
Provider Business Practice Location Address Fax Number:
508-234-6507
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRADKIN
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
OD OWNER
Authorized Official Telephone Number:
508-234-6681

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W20190 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com