Healthcare Provider Details

I. General information

NPI: 1063667046
Provider Name (Legal Business Name): CYGNUS SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 BOSTON POST RD
WESTON MA
02493-2543
US

IV. Provider business mailing address

301 BERKELEY ST APT. 2A
BOSTON MA
02116-2002
US

V. Phone/Fax

Practice location:
  • Phone: 781-686-4625
  • Fax: 857-233-5338
Mailing address:
  • Phone: 617-413-4772
  • Fax: 857-233-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number203183
License Number StateMA

VIII. Authorized Official

Name: DR. JAMES C. ALEX
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-413-4772