Provider Demographics
NPI:1295356301
Name:FCNE PHO, LLC
Entity Type:Organization
Organization Name:FCNE PHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-942-7000
Mailing Address - Street 1:20 PONDMEADOW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3222
Mailing Address - Country:US
Mailing Address - Phone:781-942-7000
Mailing Address - Fax:781-942-7200
Practice Address - Street 1:20 PONDMEADOW DR STE 101
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3222
Practice Address - Country:US
Practice Address - Phone:781-942-7000
Practice Address - Fax:781-942-7200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERTILITY CENTERS OF NEW ENGLAND, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility