Provider Demographics
NPI:1346878725
Name:DYNAMICARE HEALTH
Entity Type:Organization
Organization Name:DYNAMICARE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:GASTFRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-564-1084
Mailing Address - Street 1:6 LIBERTY SQ # 2102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:617-564-1084
Mailing Address - Fax:
Practice Address - Street 1:6 LIBERTY SQ # 2102
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-5800
Practice Address - Country:US
Practice Address - Phone:855-539-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty