Provider Demographics
NPI:1447584271
Name:KIRR, JANUS (LMT)
Entity Type:Individual
Prefix:MR
First Name:JANUS
Middle Name:
Last Name:KIRR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SARGENT ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1251
Mailing Address - Country:US
Mailing Address - Phone:781-941-0823
Mailing Address - Fax:781-662-0306
Practice Address - Street 1:2557 MASS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1020
Practice Address - Country:US
Practice Address - Phone:617-492-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2718173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist