Healthcare Provider Details

I. General information

NPI: 1669515706
Provider Name (Legal Business Name): NEW ENGLAND PODIATRY NEEDHAM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST GREEN BLDG, STE 470
NEWTON MA
02462-1650
US

IV. Provider business mailing address

PO BOX 18743
BELFAST ME
04915-4082
US

V. Phone/Fax

Practice location:
  • Phone: 617-630-8280
  • Fax: 617-630-9025
Mailing address:
  • Phone: 617-630-8280
  • Fax: 617-630-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1948
License Number StateMA

VIII. Authorized Official

Name: DR. RONALD BRIAN ETSKOVITZ
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 617-630-8280