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General NPI Number Information
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NPI Number | 1184684060
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Entity Type | Individual
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Provider Name | JACK P SYLVIA MED
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 178 PINE STREET
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City | FALL RIVER
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State | MA
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Zip | 02720
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Country | US
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Telephone | 508-678-0091
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Fax | 508-324-9002
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Provider Business Mailing Address
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Address Line | 67 BRYANT ST
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City | BERKLEY
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State | MA
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Zip | 02779-1504
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Country | US
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Telephone | 508-821-9340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3028159
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License Number State | MA
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