Provider Demographics
NPI:1750633947
Name:MASSACHUSETTS ORTHOPEDIC TREATMENT CENTER
Entity Type:Organization
Organization Name:MASSACHUSETTS ORTHOPEDIC TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NASIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-792-3200
Mailing Address - Street 1:381 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1026
Mailing Address - Country:US
Mailing Address - Phone:508-792-3200
Mailing Address - Fax:508-792-0400
Practice Address - Street 1:381 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1026
Practice Address - Country:US
Practice Address - Phone:508-792-3200
Practice Address - Fax:508-792-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty