Provider Demographics
NPI:1528125663
Name:CENTRAL MASSACHUSETTS FOOT SPECIALISTS INC.
Entity type:Organization
Organization Name:CENTRAL MASSACHUSETTS FOOT SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-757-3803
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-757-3803
Mailing Address - Fax:508-757-8011
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-757-3803
Practice Address - Fax:508-757-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2121213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9709690Medicaid
MA5091810001Medicare NSC
MAY78034Medicare PIN