Provider Demographics
NPI:1659502920
Name:MERRIMACK VALLEY FOOT SPECIALISTS ,INC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY FOOT SPECIALISTS ,INC
Other - Org Name:MERRIMACK VALLEY FOOT SPECIALISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENBLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-556-9700
Mailing Address - Street 1:62 BROWN ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:978-556-9700
Mailing Address - Fax:978-521-8542
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE 502
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-556-9700
Practice Address - Fax:978-521-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6697860001Medicare NSC
MA480019491Medicare PIN
MA5505260001Medicare NSC
MAYY8001Medicare UPIN