Provider Demographics
NPI:1255649828
Name:NEW ENGLAND TISSUE ISSUE, PLLC
Entity Type:Organization
Organization Name:NEW ENGLAND TISSUE ISSUE, PLLC
Other - Org Name:NEW ENGLAND TISSUE ISSUE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMPLIANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHSM
Authorized Official - Phone:469-532-0667
Mailing Address - Street 1:1822 N MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1822 N MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1318
Practice Address - Country:US
Practice Address - Phone:401-523-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILCO00672OtherSTATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH