Healthcare Provider Details

I. General information

NPI: 1679158703
Provider Name (Legal Business Name): NEW PATH MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BAY STATE RD APT 5
BOSTON MA
02215-2108
US

IV. Provider business mailing address

25 BAY STATE RD APT 5
BOSTON MA
02215-2108
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-6518
  • Fax:
Mailing address:
  • Phone: 617-286-6518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON CARDINAL
Title or Position: CEO
Credential:
Phone: 713-298-5197