Provider Demographics
NPI:1578002366
Name:BOSTON ORTHOPAEDIC PC
Entity Type:Organization
Organization Name:BOSTON ORTHOPAEDIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-235-3992
Mailing Address - Street 1:111 EVERETT AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2385
Mailing Address - Country:US
Mailing Address - Phone:781-235-3992
Mailing Address - Fax:781-235-3996
Practice Address - Street 1:111 EVERETT AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2385
Practice Address - Country:US
Practice Address - Phone:781-235-3992
Practice Address - Fax:781-235-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111N00000X, 207X00000X
225100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty