Provider Demographics
NPI:1801129242
Name:THE NEW ENGLAND CENTER FOR OSTEOPATHY, PLLC
Entity type:Organization
Organization Name:THE NEW ENGLAND CENTER FOR OSTEOPATHY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WALDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-526-9996
Mailing Address - Street 1:2 SOUTH ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6294
Mailing Address - Country:US
Mailing Address - Phone:413-442-5100
Mailing Address - Fax:413-442-5102
Practice Address - Street 1:2 SOUTH ST
Practice Address - Street 2:SUITE 30
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6294
Practice Address - Country:US
Practice Address - Phone:413-442-5100
Practice Address - Fax:413-442-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235587207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty