Healthcare Provider Details

I. General information

NPI: 1801059738
Provider Name (Legal Business Name): NORTH SHORE REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 WASHINGTON ST
ROSLINDALE MA
02131-1733
US

IV. Provider business mailing address

4197 WASHINGTON ST
ROSLINDALE MA
02131-1733
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-8880
  • Fax: 617-323-8886
Mailing address:
  • Phone: 617-323-8880
  • Fax: 617-323-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. ALEKSEY FLEYSHMAN
Title or Position: MANAGER
Credential:
Phone: 617-323-8880