Healthcare Provider Details

I. General information

NPI: 1093086068
Provider Name (Legal Business Name): RECOVERY FIRST PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MANNING ST SUITE 110
DERRY NH
03038-2388
US

IV. Provider business mailing address

35 WEST BROADWAY
DERRY NH
03038
US

V. Phone/Fax

Practice location:
  • Phone: 603-231-0214
  • Fax:
Mailing address:
  • Phone: 603-231-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC SPOFFORD
Title or Position: CEO
Credential:
Phone: 603-231-0214