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General NPI Number Information
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NPI Number | 1477410090
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Entity Type | Organization
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Legal Business Name | THE 21 CLUB OF CNY INC
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 100 CAMBRIDGE ST STE 1400
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City | BOSTON
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State | MA
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Zip | 02114-2545
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Country | US
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Telephone | 713-766-2796
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Fax | 712-219-5827
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Provider Business Mailing Address
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Address Line | 100 CAMBRIDGE ST STE 1400
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City | BOSTON
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State | MA
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Zip | 02114-2545
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Country | US
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Telephone | 713-766-2796
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Fax | 712-219-5827
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN WALDRON
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Credential |
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Telephone | 713-766-2796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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