Basic Information
Provider Information | |||||||||
NPI: | 1487606570 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW ENGLAND INPATIENT SPECIALIST LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 35 UNITED DR | ||||||||
Address2: | SUITE 102 | ||||||||
City: | WEST BRIDGEWATER | ||||||||
State: | MA | ||||||||
PostalCode: | 023791027 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5082388646 | ||||||||
FaxNumber: | 5082309772 | ||||||||
Practice Location | |||||||||
Address1: | 70 EAST ST | ||||||||
Address2: |   | ||||||||
City: | METHUEN | ||||||||
State: | MA | ||||||||
PostalCode: | 018444597 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9786870151 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2006 | ||||||||
LastUpdateDate: | 12/28/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JALEEL | ||||||||
AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MD | ||||||||
AuthorizedOfficialTelephone: | 5082388646 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 219219 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | M19149 | 01 | MA | BLUE SHIELD | OTHER | 0037508 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 625686 | 01 | MA | TUFTS | OTHER | 9761781 | 05 | MA |   | MEDICAID |