Healthcare Provider Details

I. General information

NPI: 1235784653
Provider Name (Legal Business Name): NORTHEAST MOMS AND BABIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OLD MILL RD
NORFOLK MA
02056-1435
US

IV. Provider business mailing address

19 OLD MILL RD
NORFOLK MA
02056-1435
US

V. Phone/Fax

Practice location:
  • Phone: 508-203-1553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIM BYDA
Title or Position: CO-FOUNDER
Credential: NP, IBCLC
Phone: 617-875-8899