Healthcare Provider Details

I. General information

NPI: 1467441923
Provider Name (Legal Business Name): ORTHOPAEDICS NORTHEAST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 STILES RD SUITE 102
SALEM NH
03079-2859
US

IV. Provider business mailing address

29 STILES RD SUITE 102
SALEM NH
03079-5802
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-2220
  • Fax: 603-890-6378
Mailing address:
  • Phone: 603-898-2220
  • Fax: 603-890-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL LEAHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-327-6561