Provider Demographics
NPI:1720707243
Name:FAMILY PHYSIATRY PC
Entity type:Organization
Organization Name:FAMILY PHYSIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-224-6420
Mailing Address - Street 1:3640 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1139
Mailing Address - Country:US
Mailing Address - Phone:413-224-6420
Mailing Address - Fax:413-224-6421
Practice Address - Street 1:3640 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1139
Practice Address - Country:US
Practice Address - Phone:413-224-6420
Practice Address - Fax:413-224-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty