Healthcare Provider Details

I. General information

NPI: 1629615828
Provider Name (Legal Business Name): CENTER FOR MORTONS NEUROMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WORCESTER RD STE 301
FRAMINGHAM MA
01702-5316
US

IV. Provider business mailing address

600 WORCESTER RD STE 301
FRAMINGHAM MA
01702-5316
US

V. Phone/Fax

Practice location:
  • Phone: 508-665-4344
  • Fax: 508-665-4355
Mailing address:
  • Phone: 508-665-4344
  • Fax: 508-665-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER AUGUSTE BEDET
Title or Position: BILLING MANAGER
Credential:
Phone: 508-665-4344