Healthcare Provider Details

I. General information

NPI: 1356704597
Provider Name (Legal Business Name): MACHLI ADRIEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 01/30/2024
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE # 112
BOSTON MA
02130-4893
US

IV. Provider business mailing address

150 S HUNTINGTON AVE # 112
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4802
  • Fax: 857-364-5036
Mailing address:
  • Phone: 857-364-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00349500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: