Provider Demographics
NPI:1710047014
Name:J&G EINSIDLER CORPORATION
Entity Type:Organization
Organization Name:J&G EINSIDLER CORPORATION
Other - Org Name:610 TREMONT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EINSIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-262-3389
Mailing Address - Street 1:610 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1600
Mailing Address - Country:US
Mailing Address - Phone:617-262-3389
Mailing Address - Fax:617-262-3913
Practice Address - Street 1:610 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1600
Practice Address - Country:US
Practice Address - Phone:617-262-3389
Practice Address - Fax:617-262-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA28083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0446769Medicaid
MA0446769Medicaid