Healthcare Provider Details

I. General information

NPI: 1558389072
Provider Name (Legal Business Name): JOHN EDWARD HURLEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

70 ALHAMBRA CIR S
AGAWAM MA
01001-2703
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6000
  • Fax: 413-788-5560
Mailing address:
  • Phone: 413-731-6000
  • Fax: 413-788-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAP1973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: