Healthcare Provider Details

I. General information

NPI: 1346774148
Provider Name (Legal Business Name): JONATHAN MAXWELL BABIARZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

PROVIDER ENROLLMENT 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-816-3700
  • Fax:
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2302541
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number085689-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7577
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2302541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: