Basic Information
| Provider Information | |||||||||
| NPI: | 1528414422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUFRONTIERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 LEICESTER WAY | ||||||||
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| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176692645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | CENTER HOUSE ROOM 246 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556506 | ||||||||
| FaxNumber: | 4014556309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 05/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARGOLIS | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9176692645 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD14779 | RI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084N0400X | MD14779 | RI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084B0040X | MD14779 | RI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
No ID Information.