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General NPI Number Information
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NPI Number | 1649392416
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE NORTH PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 225 BOSTON ST SUITE 204
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City | LYNN
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State | MA
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Zip | 01904-3137
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Country | US
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Telephone | 781-595-9581
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Fax | 781-595-9628
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Provider Business Mailing Address
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Address Line | 225 BOSTON ST SUITE 204
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City | LYNN
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State | MA
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Zip | 01904-3137
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Country | US
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Telephone | 781-595-9581
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Fax | 781-595-9628
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Authorized Official
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Title or Position | OWNER
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Name | WALTER J NALESNIK
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Credential | MD
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Telephone | 781-595-9581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53680
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License Number State | MA
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