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General NPI Number Information
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NPI Number | 1275986978
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Entity Type | Organization
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Legal Business Name | GAZEBO, INC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 14 CENTER ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3005
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Country | US
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Telephone | 413-584-6673
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Fax | 413-584-0195
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Provider Business Mailing Address
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Address Line | 14 CENTER ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3005
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Country | US
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Telephone | 413-584-6673
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Fax | 413-584-0195
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Authorized Official
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Title or Position | TREASURER
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Name | DONNA MCNEIGHT
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Credential |
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Telephone | 413-584-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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