Provider Demographics
NPI:1154433878
Name:ZDOROVIE SENIOR SERVICES
Entity type:Organization
Organization Name:ZDOROVIE SENIOR SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:BAUDINOVICH
Authorized Official - Last Name:MAZAEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:617-795-0668
Mailing Address - Street 1:149 CALIFORNIA ST # A
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1023
Mailing Address - Country:US
Mailing Address - Phone:617-795-0668
Mailing Address - Fax:617-795-0668
Practice Address - Street 1:149 CALIFORNIA ST # A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1023
Practice Address - Country:US
Practice Address - Phone:617-795-0668
Practice Address - Fax:617-795-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1906216261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1906216Medicaid