Provider Demographics
NPI:1609209402
Name:PJM INC
Entity Type:Organization
Organization Name:PJM INC
Other - Org Name:FITNESS UNLIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-698-0260
Mailing Address - Street 1:364 GRANITE AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5025
Mailing Address - Country:US
Mailing Address - Phone:617-698-0260
Mailing Address - Fax:617-698-6162
Practice Address - Street 1:364 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5025
Practice Address - Country:US
Practice Address - Phone:617-698-0260
Practice Address - Fax:617-698-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3015OtherLDN
MA2449OtherLDN