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General NPI Number Information
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NPI Number | 1407079759
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Entity Type | Organization
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Legal Business Name | NORTH SHORE REHABILITATION ASSOCIATES INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 121 BROAD STREET
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City | LYNN
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State | MA
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Zip | 01901-1629
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Country | US
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Telephone | 781-593-9090
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Fax | 780-593-9093
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Provider Business Mailing Address
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Address Line | 121 BROAD STREET
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City | LYNN
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State | MA
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Zip | 01901-1629
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Country | US
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Telephone | 781-593-9090
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Fax | 780-593-9093
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEX PYATIGORSKIY
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Credential |
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Telephone | 781-593-9093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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