Provider Demographics
NPI:1114484953
Name:NEW ENGLAND FOOD ALLERGY TREATMENT CENTER- BOSTON
Entity Type:Organization
Organization Name:NEW ENGLAND FOOD ALLERGY TREATMENT CENTER- BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VALLEN MASHIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-718-6812
Mailing Address - Street 1:151 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4615
Mailing Address - Country:US
Mailing Address - Phone:781-718-6812
Mailing Address - Fax:
Practice Address - Street 1:700 CONGRESS ST STE 305
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0909
Practice Address - Country:US
Practice Address - Phone:781-718-6812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty