Provider Demographics
NPI:1558731711
Name:FIVE JOURNEYS, PC
Entity Type:Organization
Organization Name:FIVE JOURNEYS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-934-6400
Mailing Address - Street 1:181 WELLS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3344
Mailing Address - Country:US
Mailing Address - Phone:617-934-6400
Mailing Address - Fax:617-934-6401
Practice Address - Street 1:181 WELLS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3344
Practice Address - Country:US
Practice Address - Phone:617-934-6400
Practice Address - Fax:617-934-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222719207Q00000X
207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty