Healthcare Provider Details

I. General information

NPI: 1275665952
Provider Name (Legal Business Name): MASS BAY RESPIRATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EAST ST.
HANOVER MA
02339
US

IV. Provider business mailing address

10 EAST ST.
HANOVER MA
02339
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-9797
  • Fax: 781-826-0080
Mailing address:
  • Phone: 781-826-9797
  • Fax: 781-826-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1540459
License Number StateMA

VIII. Authorized Official

Name: MS. DIANNE MARIE LONG
Title or Position: VP
Credential:
Phone: 781-826-9797