Provider Demographics
NPI:1467543710
Name:HYDE PARK HEALTH ASSOCIATES INC.
Entity Type:Organization
Organization Name:HYDE PARK HEALTH ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-954-2351
Mailing Address - Street 1:745 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1941
Mailing Address - Country:US
Mailing Address - Phone:617-364-2588
Mailing Address - Fax:
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73981261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA73981OtherLICENSE
MADEABB2703513OtherMASS HEALTH
MAE99158Medicare UPIN