Provider Demographics
NPI:1053476531
Name:NORTH SHORE REHABILITATION ASSOCIATES INC.
Entity Type:Organization
Organization Name:NORTH SHORE REHABILITATION ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PYATIGORSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-593-9093
Mailing Address - Street 1:121 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1629
Mailing Address - Country:US
Mailing Address - Phone:781-593-9090
Mailing Address - Fax:781-593-9093
Practice Address - Street 1:121 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1629
Practice Address - Country:US
Practice Address - Phone:781-593-9090
Practice Address - Fax:781-593-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA76157OtherHARVARD PILGRIM HEALTH
MA644740OtherTUFTS
MAPT0272OtherCOMMONWEALTH CARE ALLIAN.
MA9751441Medicaid
MAY61455OtherBCBS
MA0038052OtherNEIGHBORHOOD HEALTH PLAN
MA9751441Medicaid