Provider Demographics
NPI:1003805540
Name:ORTHOPAEDICS NORTHEAST P.C.
Entity Type:Organization
Organization Name:ORTHOPAEDICS NORTHEAST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-327-6561
Mailing Address - Street 1:575 TURNPIKE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5924
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:978-975-3925
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5924
Practice Address - Country:US
Practice Address - Phone:978-794-1946
Practice Address - Fax:978-975-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9740457Medicaid
MA9740457Medicaid
0389230001Medicare NSC