Provider Demographics
NPI:1568798510
Name:NANTUCKET PHYSICIANS ORGANIZATION
Entity Type:Organization
Organization Name:NANTUCKET PHYSICIANS ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MALLOY
Authorized Official - Last Name:MONTO
Authorized Official - Suffix:
Authorized Official - Credentials:JD, RN
Authorized Official - Phone:508-825-1327
Mailing Address - Street 1:57 PROSPECT ST
Mailing Address - Street 2:ROOM 122
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-825-1327
Mailing Address - Fax:508-825-8379
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:ROOM 101
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-776-7428
Practice Address - Fax:508-693-5942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTUCKET COTTAGE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-27
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242762207Q00000X
MA150697207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty