Provider Demographics
NPI:1386198810
Name:NEW ENGLAND HOSPITALISTS
Entity Type:Organization
Organization Name:NEW ENGLAND HOSPITALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-735-3280
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2583
Mailing Address - Country:US
Mailing Address - Phone:508-450-9450
Mailing Address - Fax:
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-450-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-13
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA282464Medicaid
MA282464Medicare PIN
MA282464Medicare Oscar/Certification
MA282464Medicare UPIN