Provider Demographics
NPI:1194005561
Name:JOHN L PRZYBYLSKI MD PC
Entity Type:Organization
Organization Name:JOHN L PRZYBYLSKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRZYBYLSKI MD PC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-221-0055
Mailing Address - Street 1:25 MALL RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4156
Mailing Address - Country:US
Mailing Address - Phone:781-221-0055
Mailing Address - Fax:
Practice Address - Street 1:25 MALL RD
Practice Address - Street 2:SUITE 501
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4156
Practice Address - Country:US
Practice Address - Phone:781-221-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2013924Medicaid
MAB47150OtherBLUE CROSS
MA2013924Medicaid