Provider Demographics
NPI:1114986080
Name:RISTEM, TERESE A (CMRS, CPC)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:A
Last Name:RISTEM
Suffix:
Gender:F
Credentials:CMRS, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BROADWAY
Mailing Address - Street 2:SUITE 395
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6827
Mailing Address - Country:US
Mailing Address - Phone:978-683-5115
Mailing Address - Fax:978-683-7337
Practice Address - Street 1:116 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3703
Practice Address - Country:US
Practice Address - Phone:978-683-5115
Practice Address - Fax:978-683-7337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist