Provider Demographics
NPI:1396885513
Name:CITY OF NORTHAMPTON
Entity type:Organization
Organization Name:CITY OF NORTHAMPTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CHO
Authorized Official - Phone:413-587-1215
Mailing Address - Street 1:212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3112
Mailing Address - Country:US
Mailing Address - Phone:413-587-1215
Mailing Address - Fax:413-587-1221
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3112
Practice Address - Country:US
Practice Address - Phone:413-587-1215
Practice Address - Fax:413-587-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11081Medicare ID - Type Unspecified