Healthcare Provider Details

I. General information

NPI: 1558731711
Provider Name (Legal Business Name): FIVE JOURNEYS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 WELLS AVE SUITE 202
NEWTON MA
02459-3344
US

IV. Provider business mailing address

181 WELLS AVE SUITE 202
NEWTON MA
02459-3344
US

V. Phone/Fax

Practice location:
  • Phone: 617-934-6400
  • Fax: 617-934-6401
Mailing address:
  • Phone: 617-934-6400
  • Fax: 617-934-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number222719
License Number StateMA

VIII. Authorized Official

Name: EDWARD LEVITAN
Title or Position: CEO
Credential: MD
Phone: 617-934-6400