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General NPI Number Information
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NPI Number | 1629497417
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Entity Type | Organization
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Legal Business Name | HARBORMED LLC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 21 SCHOOL ST SUITE 1
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City | QUINCY
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State | MA
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Zip | 02169-6640
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Country | US
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Telephone | 617-332-4780
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Fax |
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Provider Business Mailing Address
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Address Line | 17 EDGE HILL RD
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-1170
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Country | US
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Telephone | 617-332-4780
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Fax | 815-846-0956
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. ISRAEL MAYER STEIN
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Credential | MD
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Telephone | 617-332-4780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 33623
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License Number State | MA
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