Provider Demographics
NPI:1598578064
Name:GBU UMASS LLC
Entity type:Organization
Organization Name:GBU UMASS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT BUSINESS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:781-337-0201
Mailing Address - Street 1:51 MILL ST, BLDG F
Mailing Address - Street 2:SUITE A
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-6022
Mailing Address - Country:US
Mailing Address - Phone:781-337-0201
Mailing Address - Fax:
Practice Address - Street 1:910 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6033
Practice Address - Country:US
Practice Address - Phone:781-762-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty