Healthcare Provider Details

I. General information

NPI: 1932180122
Provider Name (Legal Business Name): MICHAEL STEVEN JELLINEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

40 CRESCENT AVE
NEWTON MA
02459-2102
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8610
  • Fax: 781-744-5235
Mailing address:
  • Phone: 617-650-9361
  • Fax: 617-467-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39338
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number39338
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: