Provider Demographics
NPI:1063190353
Name:MARBLEHEAD OPHTHALMOLOGY 2 LLC
Entity type:Organization
Organization Name:MARBLEHEAD OPHTHALMOLOGY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ORENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-696-8490
Mailing Address - Street 1:1 WIDGER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2100
Mailing Address - Country:US
Mailing Address - Phone:781-696-8490
Mailing Address - Fax:
Practice Address - Street 1:1 WIDGER RD STE 108
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2100
Practice Address - Country:US
Practice Address - Phone:781-631-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARBLEHEAD OPHTHALMOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty