Healthcare Provider Details

I. General information

NPI: 1962439240
Provider Name (Legal Business Name): NORTHERN PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE ST SUITE 5980
BOSTON MA
02130-3446
US

IV. Provider business mailing address

1153 CENTER STREET SUITE 5980
BOSTON MA
02130-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-1900
  • Fax: 617-983-8122
Mailing address:
  • Phone: 617-983-1900
  • Fax: 617-983-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RAMIRO J MANZANO
Title or Position: PHYSICIAN
Credential: D.P.M.
Phone: 671-983-1900