Healthcare Provider Details

I. General information

NPI: 1144151028
Provider Name (Legal Business Name): MR. STEFAN HAREL KALT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 WASHINGTON ST
NORWELL MA
02061-2010
US

IV. Provider business mailing address

144 ELM ST
QUINCY MA
02169-5412
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-6550
  • Fax:
Mailing address:
  • Phone: 617-390-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: