Provider Demographics
NPI:1609235225
Name:BOSTON CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:BOSTON CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOWSHIP PROGRAM COORDINATOR PEDI
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-355-5888
Mailing Address - Street 1:11 JANEWAY PLACE
Mailing Address - Street 2:UNIT 404
Mailing Address - City:ST. JOHN'S
Mailing Address - State:NL
Mailing Address - Zip Code:A1A1R7
Mailing Address - Country:CA
Mailing Address - Phone:709-579-6428
Mailing Address - Fax:
Practice Address - Street 1:11 JANEWAY PLACE
Practice Address - Street 2:UNIT 404
Practice Address - City:ST. JOHN'S
Practice Address - State:NL
Practice Address - Zip Code:A1A1R7
Practice Address - Country:CA
Practice Address - Phone:709-579-6428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260522282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren