Provider Demographics
NPI:1407996911
Name:CITY OF WALTHAM
Entity Type:Organization
Organization Name:CITY OF WALTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PINZONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-314-5420
Mailing Address - Street 1:617 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-3003
Mailing Address - Country:US
Mailing Address - Phone:781-314-5420
Mailing Address - Fax:781-314-5540
Practice Address - Street 1:617 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-3003
Practice Address - Country:US
Practice Address - Phone:781-314-5420
Practice Address - Fax:781-314-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951912Medicaid