Provider Demographics
NPI:1205042397
Name:EDWARD T HURWITZ DPM PC
Entity Type:Organization
Organization Name:EDWARD T HURWITZ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-444-6847
Mailing Address - Street 1:394 W BROADWAY
Mailing Address - Street 2:PO BOX E 13
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2215
Mailing Address - Country:US
Mailing Address - Phone:781-444-6847
Mailing Address - Fax:617-414-6710
Practice Address - Street 1:394 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2215
Practice Address - Country:US
Practice Address - Phone:781-444-6847
Practice Address - Fax:617-414-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1366213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58556Medicare UPIN