Provider Demographics
NPI:1124180443
Name:AJINOMOTO CAMBROOKE, INC.
Entity type:Organization
Organization Name:AJINOMOTO CAMBROOKE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-862-1902
Mailing Address - Street 1:4 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1751
Mailing Address - Country:US
Mailing Address - Phone:978-862-1905
Mailing Address - Fax:508-416-0067
Practice Address - Street 1:4 COPELAND DR
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1751
Practice Address - Country:US
Practice Address - Phone:978-862-1905
Practice Address - Fax:508-416-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MAMA-7335332B00000X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
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MN103968OtherUCARE OF MN
MA000000022076OtherBMC HEALTH NET
NY00588237002OtherBCBS OF WESTERN NY
36844OtherMVP HEALTHCARE
MA704879OtherHARVARD PILGRIM
MA694981OtherTUFTS
8290130OtherMEDICA
MN919669200OtherMN HEALTHCARE PROGRAMS
95Z042019MA01OtherANTHEM BCBS
95Z042019MA01OtherANTHEM BCBS