Healthcare Provider Details

I. General information

NPI: 1396991709
Provider Name (Legal Business Name): NORTHEAST HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK STREET
BEVERLY MA
01915
US

IV. Provider business mailing address

85 HERRICK STREET MEDICAL STAFF OFFICE
BEVERLY MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7880
  • Fax: 978-921-7048
Mailing address:
  • Phone: 978-922-3000
  • Fax: 978-921-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number15
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier600529
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS

VIII. Authorized Official

Name: MR. DENIS CONROY
Title or Position: CEO
Credential:
Phone: 978-922-3000