Provider Demographics
NPI:1033351770
Name:ASSABET FAMILY PODIATRY, INC
Entity Type:Organization
Organization Name:ASSABET FAMILY PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-481-3659
Mailing Address - Street 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-481-3659
Mailing Address - Fax:508-460-9728
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-481-3659
Practice Address - Fax:508-460-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2090213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1497861587OtherINDIVIDUAL NPI #
MA0316610Medicaid
MA0316610Medicaid
MAY75037Medicare PIN
MAY75123Medicare PIN