Provider Demographics
NPI:1144412396
Name:ALLA I. NEYSHTADT, M.D., PC..
Entity Type:Organization
Organization Name:ALLA I. NEYSHTADT, M.D., PC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYSHTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-630-9823
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:BLUE BUILDING, SUITE 420
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-630-9823
Mailing Address - Fax:617-630-4481
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:BLUE BUILDING, SUITE 420
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-630-9823
Practice Address - Fax:617-630-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150852207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3153380Medicaid
MAG27106Medicare UPIN