Healthcare Provider Details

I. General information

NPI: 1902627680
Provider Name (Legal Business Name): NORTHEAST ORTHOPAEDIC ALLIANCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325B KING ST
NORTHAMPTON MA
01060-2370
US

IV. Provider business mailing address

PO BOX 791835
BALTIMORE MD
21279-1835
US

V. Phone/Fax

Practice location:
  • Phone: 413-785-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN R CORSETTI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 413-785-4666