Provider Demographics
NPI:1699789339
Name:NEEDHAM GASTROENTEROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NEEDHAM GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-444-6460
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0419
Mailing Address - Country:US
Mailing Address - Phone:781-444-6460
Mailing Address - Fax:781-455-0169
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-444-6460
Practice Address - Fax:781-455-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76834207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17267OtherBCBS
MAM21892Medicare PIN
MA9787321Medicaid