Healthcare Provider Details

I. General information

NPI: 1316212384
Provider Name (Legal Business Name): NEW ENGLAND HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CHELMSFORD ST
CHELMSFORD MA
01824-3017
US

IV. Provider business mailing address

34 CHELMSFORD ST
CHELMSFORD MA
01824-3017
US

V. Phone/Fax

Practice location:
  • Phone: 978-244-9355
  • Fax: 978-244-9356
Mailing address:
  • Phone: 978-244-9355
  • Fax: 978-244-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN P. BRODERICK SR.
Title or Position: PRESIDENT/OWNER
Credential: D. C.
Phone: 978-244-9355