Provider Demographics
NPI:1518144252
Name:TWINBROOK UROLOGICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:TWINBROOK UROLOGICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-893-4555
Mailing Address - Street 1:20 HOPE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2721
Mailing Address - Country:US
Mailing Address - Phone:781-893-4555
Mailing Address - Fax:781-893-5583
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-893-4555
Practice Address - Fax:781-893-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11636OtherBLUE CROSS
MA9706569Medicaid
MA701442OtherTUFTS
MAM11636OtherBLUE CROSS