Provider Demographics
NPI:1588707442
Name:PAUL M CANGIANO INC
Entity type:Organization
Organization Name:PAUL M CANGIANO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-227-2010
Mailing Address - Street 1:77 N WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1908
Mailing Address - Country:US
Mailing Address - Phone:617-227-2010
Mailing Address - Fax:617-227-1997
Practice Address - Street 1:77 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1908
Practice Address - Country:US
Practice Address - Phone:617-227-2010
Practice Address - Fax:617-227-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W21087OtherBCBS
W21087Medicare ID - Type Unspecified