Healthcare Provider Details

I. General information

NPI: 1750521563
Provider Name (Legal Business Name): HYMAN SAMUEL BESHANSKY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GOVERNORS AVE
MEDFORD MA
02155-1643
US

IV. Provider business mailing address

963 LOWELL RD
GROTON MA
01450-1549
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-6139
  • Fax: 781-306-6020
Mailing address:
  • Phone: 978-272-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number218435
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: