Provider Demographics
NPI:1285973552
Name:UNITED ESOTERICS CORP
Entity type:Organization
Organization Name:UNITED ESOTERICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOCKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:781-729-1700
Mailing Address - Street 1:21G OLYMPIA AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6328
Mailing Address - Country:US
Mailing Address - Phone:781-729-1700
Mailing Address - Fax:
Practice Address - Street 1:21G OLYMPIA AVE STE 50
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6328
Practice Address - Country:US
Practice Address - Phone:781-729-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory