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General NPI Number Information
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NPI Number | 1417724170
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORTHOPAEDIC ALLIANCE PLLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 71 BORDER RD STE 300
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City | WALTHAM
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State | MA
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Zip | 02451-1044
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Country | US
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Telephone | 781-890-2133
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Fax | 781-890-2177
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Provider Business Mailing Address
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Address Line | 71 BORDER RD STE 300
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City | WALTHAM
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State | MA
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Zip | 02451-1044
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Country | US
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Telephone | 781-890-2133
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Fax | 781-890-2177
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOHN R CORSETTI
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Credential |
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Telephone | 413-785-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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