Provider Demographics
NPI:1205829579
Name:NEW ENGLAND NEUROLOGICAL
Entity Type:Organization
Organization Name:NEW ENGLAND NEUROLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-687-2321
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:BLDG. 1
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-685-7265
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:BLDG. 1
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-685-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA97497OtherUSHC
NH99903151Medicaid
MA701417OtherTHP
MAM11158OtherBCBSMA PHYSICIAN
MAW10119OtherBCBSMA PSYCHOLOGIST
MA9711694Medicaid
NHRE1072Medicare PIN
MA9711694Medicaid
MAM11158OtherBCBSMA PHYSICIAN