=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942376009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEIN AND LASER CENTER OF NEW ENGLAND PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 04/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 RESNIK ROAD SUITE 305
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-747-1333
-----------------------------------------------------
Fax | 508-747-2850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 RESNIK ROAD SUITE 305
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-747-1333
-----------------------------------------------------
Fax | 508-747-2850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KIMBERLY JEAN SEMATONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-747-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------