Healthcare Provider Details

I. General information

NPI: 1619567195
Provider Name (Legal Business Name): J.EDMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOYLSTON ST UNIT 809
BOSTON MA
02215-5524
US

IV. Provider business mailing address

1330 BOYLSTON ST UNIT 809
BOSTON MA
02215-5524
US

V. Phone/Fax

Practice location:
  • Phone: 410-935-4608
  • Fax:
Mailing address:
  • Phone: 410-935-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY VOGEL
Title or Position: OWNER
Credential: MD
Phone: 410-935-4608