Healthcare Provider Details

I. General information

NPI: 1629592324
Provider Name (Legal Business Name): JOE OPALKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRIFFIN RD STE 5
PORTSMOUTH NH
03801-7145
US

IV. Provider business mailing address

200 GRIFFIN RD STE 5
PORTSMOUTH NH
03801-7145
US

V. Phone/Fax

Practice location:
  • Phone: 800-778-5560
  • Fax: 800-778-5560
Mailing address:
  • Phone: 800-778-5560
  • Fax: 800-778-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: