Provider Demographics
NPI:1629310214
Name:SUFFOLK UNIVERSITY HEALTH AND WELLNESS SERVICES OFFICE
Entity Type:Organization
Organization Name:SUFFOLK UNIVERSITY HEALTH AND WELLNESS SERVICES OFFICE
Other - Org Name:SUFFOLK UNIVERSITY HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-573-8400
Mailing Address - Street 1:8 ASHBURTON PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2701
Mailing Address - Country:US
Mailing Address - Phone:617-573-8260
Mailing Address - Fax:
Practice Address - Street 1:73 TREMONT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3916
Practice Address - Country:US
Practice Address - Phone:617-573-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Single Specialty