Provider Demographics
NPI:1225194509
Name:BOSTON HAND TO SHOULDER PC
Entity type:Organization
Organization Name:BOSTON HAND TO SHOULDER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-965-4263
Mailing Address - Street 1:159 WELLS AVENUE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3301
Mailing Address - Country:US
Mailing Address - Phone:617-965-4263
Mailing Address - Fax:617-928-0597
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 563
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1629
Practice Address - Country:US
Practice Address - Phone:617-965-4263
Practice Address - Fax:617-928-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9726888Medicaid
5977660001Medicare NSC
MA9726888Medicaid