Healthcare Provider Details

I. General information

NPI: 1255649828
Provider Name (Legal Business Name): NEW ENGLAND TISSUE ISSUE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 N MAIN ST SUITE 302
FALL RIVER MA
02720-1318
US

IV. Provider business mailing address

1822 N MAIN ST SUITE 302
FALL RIVER MA
02720-1318
US

V. Phone/Fax

Practice location:
  • Phone: 401-523-7512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLCO00672
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerSTATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH

VIII. Authorized Official

Name: MRS. ILSA MARIE RAMIREZ
Title or Position: COMPLIANCE SPECIALIST
Credential: MBA, MHSM
Phone: 469-532-0667