| NPI | 1033778824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN VALANZOLA Credentialing Supervisor 781-681-0384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 208800000X Urology | |
| 208D00000X General Practice | |
| 213E00000X Podiatrist | |
| 207KA0200X Allergy & Immunology, Allergy | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2024-01-23 |