Provider Demographics
NPI:1669515706
Name:NEW ENGLAND PODIATRY NEEDHAM, PC
Entity type:Organization
Organization Name:NEW ENGLAND PODIATRY NEEDHAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ETSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-630-8280
Mailing Address - Street 1:PO BOX 18743
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4082
Mailing Address - Country:US
Mailing Address - Phone:617-630-8280
Mailing Address - Fax:617-630-9025
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:GREEN BLDG, STE 470
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-630-8280
Practice Address - Fax:617-630-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1948213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77127Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER