Healthcare Provider Details

I. General information

NPI: 1467759977
Provider Name (Legal Business Name): ASSOCIATED FOOT AND ANKLE SURGEONS OF NEW ENGLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

464 COMMON ST # 307
BELMONT MA
02478-2704
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5065
  • Fax: 617-321-4075
Mailing address:
  • Phone: 888-352-0082
  • Fax: 617-321-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD1920
License Number StateMA

VIII. Authorized Official

Name: DR. PHILIP BASILE
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 888-352-0082