Provider Demographics
NPI:1760449979
Name:NEW ENGLAND EYE SURGICAL ASSOC
Entity Type:Organization
Organization Name:NEW ENGLAND EYE SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-331-3820
Mailing Address - Street 1:696 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1842
Mailing Address - Country:US
Mailing Address - Phone:781-331-3820
Mailing Address - Fax:781-331-1076
Practice Address - Street 1:696 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1842
Practice Address - Country:US
Practice Address - Phone:781-331-3820
Practice Address - Fax:781-331-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
727623OtherTUFTS
603412OtherHPHC
M14341OtherBCBS
603412OtherHPHC