Healthcare Provider Details

I. General information

NPI: 1679206403
Provider Name (Legal Business Name): BOSTON SPECIALISTS - NWH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HARRISON AVE STE 201
BOSTON MA
02111-1924
US

IV. Provider business mailing address

1 NASSAU STREET UNIT 1906
BOSTON MA
02111-1587
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-6767
  • Fax: 877-726-8492
Mailing address:
  • Phone: 617-804-6767
  • Fax: 877-726-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LEUNG
Title or Position: DIRECTOR
Credential: MD
Phone: 734-846-4910