Provider Demographics
NPI:1073941464
Name:NORTHEAST EVALUATION SPECIALISTS
Entity Type:Organization
Organization Name:NORTHEAST EVALUATION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:888-575-4202
Mailing Address - Street 1:1 WASHINGTON ST STE 443
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3831
Mailing Address - Country:US
Mailing Address - Phone:888-575-4202
Mailing Address - Fax:603-742-1414
Practice Address - Street 1:190 RIVERSIDE ST UNIT 4A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1073
Practice Address - Country:US
Practice Address - Phone:888-575-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1541261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1295991164OtherCMS