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General NPI Number Information
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NPI Number | 1942819172
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Entity Type | Organization
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Legal Business Name | NEV BURLINGTON LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 101 MIDDLESEX TPKE
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City | BURLINGTON
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State | MA
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Zip | 01803-4934
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Country | US
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Telephone | 781-270-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PITMAN DR
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City | READING
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State | MA
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Zip | 01867-1959
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Country | US
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Telephone | 781-910-5555
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Fax |
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Authorized Official
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Title or Position | MANAGER OWNER / OPTICIAN
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Name | MR. CARMINE MAZZARELLA
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Credential | DO
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Telephone | 781-910-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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