Provider Demographics
NPI:1114340619
Name:BOSTON PEDORTHIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BOSTON PEDORTHIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-787-8779
Mailing Address - Street 1:1929 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5939
Mailing Address - Country:US
Mailing Address - Phone:617-787-8779
Mailing Address - Fax:270-747-8779
Practice Address - Street 1:508 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4237
Practice Address - Country:US
Practice Address - Phone:781-933-2345
Practice Address - Fax:270-404-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1856251Medicaid
MA4843760002OtherPTAN