Healthcare Provider Details

I. General information

NPI: 1497156392
Provider Name (Legal Business Name): THE SPIEGEL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BOYLSTON STREET FRONT
NEWTON MA
02459
US

IV. Provider business mailing address

335 BOYLSTON STREET FRONT
NEWTON MA
02459
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-3223
  • Fax: 617-566-3220
Mailing address:
  • Phone: 617-566-3223
  • Fax: 617-566-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number205428
License Number StateMA

VIII. Authorized Official

Name: JEFFREY H SPIEGEL
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 617-566-3223