Provider Demographics
NPI:1548425572
Name:MASSACHUSETTS EYE AND EAR INFIRMARY
Entity Type:Organization
Organization Name:MASSACHUSETTS EYE AND EAR INFIRMARY
Other - Org Name:MASSACHUSETTS EYE AND EAR ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:617-573-3380
Mailing Address - Street 1:243 CHARLES ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-3380
Mailing Address - Fax:
Practice Address - Street 1:243 CHARLES ST FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty