Healthcare Provider Details

I. General information

NPI: 1629294061
Provider Name (Legal Business Name): CENTER FOR CONTINENCE CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 YORK ST
STOUGHTON MA
02072-1829
US

IV. Provider business mailing address

1 EDWARD ST
CANTON MA
02021-2303
US

V. Phone/Fax

Practice location:
  • Phone: 781-297-1391
  • Fax: 781-828-2471
Mailing address:
  • Phone: 781-828-3533
  • Fax: 781-828-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32227
License Number StateMA

VIII. Authorized Official

Name: ROBERT MIRKIN SCHLESINGER
Title or Position: OWNER
Credential: M.D.
Phone: 781-828-3533