Provider Demographics
NPI:1003208216
Name:ESSEX NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ESSEX NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-532-8010
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2904
Mailing Address - Country:US
Mailing Address - Phone:978-532-8010
Mailing Address - Fax:978-532-5147
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 307
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2904
Practice Address - Country:US
Practice Address - Phone:978-532-8010
Practice Address - Fax:978-532-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM12672Medicare UPIN