Provider Demographics
NPI:1316212384
Name:NEW ENGLAND HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:NEW ENGLAND HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:SR
Authorized Official - Credentials:D C
Authorized Official - Phone:978-244-9355
Mailing Address - Street 1:34 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3017
Mailing Address - Country:US
Mailing Address - Phone:978-244-9355
Mailing Address - Fax:978-244-9356
Practice Address - Street 1:34 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3017
Practice Address - Country:US
Practice Address - Phone:978-244-9355
Practice Address - Fax:978-244-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0026414Medicare PIN