Northeast Medical Group, Inc.
Legal Business Name
Northeast Medical Group, Inc.
NPI Number
1043278351
NPI Type
Organization
Enumeration Date
05/03/2006
Specialties
(Taxonomies)Name
Code
1041C0700X
207P00000X
213ES0103X
106H00000X
363L00000X
208000000X
2084P0800X
133V00000X
208600000X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 415126
226 MILL HILL AVENUE
City
Boston
Bridgeport
State
MA
CT
Postal Code
02241-0001
06610
Country
US
US
Telephone Number
(203) 384-3975
(203) 384-3975
Authorized Official
Name
Beata Bialczak
Title or Position
MANAGER
Telephone Number
(203) 384-3975
Identifiers
Identifier
004112257
008008038
004118388
004223517
004118396
008001858
004212958
004229317
008002043
Unknown
Unknown
Unknown
Identifier State
CT
CT
CT
CT
CT
CT
CT
CT
CT
Unknown
Unknown
Unknown
Identifier Issuer
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 12/22/2021