=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861556961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDDLEBORO PEDIATRICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 LAKEVILLE BUSINESS PARK
-----------------------------------------------------
City | LAKEVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02347-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-0630
-----------------------------------------------------
Fax | 508-947-0639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 LAKEVILLE BUSINESS PARK
-----------------------------------------------------
City | LAKEVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02347-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-0630
-----------------------------------------------------
Fax | 508-947-0639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NEAL GERALD BORNSTEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 508-947-0630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------