Basic Information
| Provider Information | |||||||||
| NPI: | 1952517013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLEASANT VALLEY INTERNISTS P.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786890869 | ||||||||
| FaxNumber: | 9786893096 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 EAST ST | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786890869 | ||||||||
| FaxNumber: | 9786893096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THAVASEELAN | ||||||||
| AuthorizedOfficialFirstName: | PERIN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9786890869 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 55639 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1861409989 | 01 | MA | NPI NBR | OTHER | 1417959776 | 01 | MA | NPI SALAH ABASS | OTHER | 2085780 | 05 | MA | MEDICAID | 0171557 | 05 | MA | MEDICAID |