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General NPI Number Information
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NPI Number | 1982076535
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Entity Type | Organization
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Legal Business Name | PRUSTY ENDOCRINE ASSOCIATES
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 571 MAIN ST SECOND FLOOR
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-1843
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Country | US
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Telephone | 617-335-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 571 MAIN ST SECOND FLOOR
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-1843
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Country | US
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Telephone | 617-335-9363
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEEPANWITA PRUSTY
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Credential | M.D.
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Telephone | 617-335-9363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 228973
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License Number State | MA
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