Provider Demographics
NPI:1114052784
Name:ROBERT H OSOFSKY MD PC
Entity Type:Organization
Organization Name:ROBERT H OSOFSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:OSOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-734-4918
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-734-4918
Mailing Address - Fax:413-734-4919
Practice Address - Street 1:299 CAREW ST.
Practice Address - Street 2:SUITE 330
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-734-4918
Practice Address - Fax:413-734-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39759207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA725030OtherTUFTS HEALTH PLANS
MA2045206Medicaid
MAN51652OtherBLUE CROSS BLUE SHILED MA
MA15134OtherHEALTH NEW ENGLAND
MAN51652OtherBLUE CROSS BLUE SHILED MA
MA2045206Medicaid