Provider Demographics
NPI:1114273612
Name:GREATER BOSTON ORTHOPEDIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:GREATER BOSTON ORTHOPEDIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:DABUZHSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-335-6622
Mailing Address - Street 1:114 WHITWELL ST
Mailing Address - Street 2:FLOOR A-4
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1870
Mailing Address - Country:US
Mailing Address - Phone:781-355-6622
Mailing Address - Fax:617-376-5683
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:FLOOR A-4
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:781-355-6622
Practice Address - Fax:617-376-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty