Healthcare Provider Details

I. General information

NPI: 1649392416
Provider Name (Legal Business Name): PRIMARY CARE NORTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BOSTON ST SUITE 204
LYNN MA
01904-3137
US

IV. Provider business mailing address

225 BOSTON ST SUITE 204
LYNN MA
01904-3137
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-9581
  • Fax: 781-595-9628
Mailing address:
  • Phone: 781-595-9581
  • Fax: 781-595-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53680
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALTER J NALESNIK
Title or Position: OWNER
Credential: MD
Phone: 781-595-9581