1629025077 NPI number — NORTHERN ESSEX WOMEN'S HEALTH, PC

Table of content: (NPI 1629025077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629025077 NPI number — NORTHERN ESSEX WOMEN'S HEALTH, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ESSEX WOMEN'S HEALTH, 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:
NORTHERN ESSEX OBGYN ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1629025077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 MERRIMACK ST
Provider Second Line Business Mailing Address:
ENTRANCE G
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-557-9060
Provider Business Mailing Address Fax Number:
978-557-9064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 MERRIMACK ST
Provider Second Line Business Practice Location Address:
ENTRANCE G
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01843-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-557-9060
Provider Business Practice Location Address Fax Number:
978-557-9064
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHUN
Authorized Official First Name:
BYUNGYOL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
978-556-9060

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 043572001 . This is a "SENIOR WHOLE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9708146 . This is a "MASS HEALTH HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: M17811 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690487 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA7668 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "HEALTH SOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80520 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "UNITED HEALTH CARE NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30211826 . This is a "NEW HAMPSHIRE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: M20997 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0023344 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043572001 . This is a "HEALTH CARE VALUE MGT" identifier . This identifiers is of the category "OTHER".




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