Healthcare Provider Details

I. General information

NPI: 1235099441
Provider Name (Legal Business Name): EAZYFIT CRANIAL PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4988 WASHINGTON ST
WEST ROXBURY MA
02132-4747
US

IV. Provider business mailing address

51 NORFOLK ST APT C
DORCHESTER CENTER MA
02124-3576
US

V. Phone/Fax

Practice location:
  • Phone: 857-237-6134
  • Fax:
Mailing address:
  • Phone: 857-237-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: EZRA LIVERPOOL
Title or Position: OWNER
Credential:
Phone: 857-237-6134