1073620019 NPI number — MEDICAL EQUIPMENT & DEVICES INC

Table of content: (NPI 1073620019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073620019 NPI number — MEDICAL EQUIPMENT & DEVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EQUIPMENT & DEVICES INC
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:
1073620019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 WINTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02188-3367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-337-3070
Provider Business Mailing Address Fax Number:
781-337-9709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 WINTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02188-3367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-337-3070
Provider Business Practice Location Address Fax Number:
781-337-9709
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CERUNDOLO
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-337-3070

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1527134 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806154 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 197954 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701005 . This is a "HARVARD COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2407 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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