Provider Demographics
NPI:1760679013
Name:TOWN OF TYNGSBOROUGH
Entity Type:Organization
Organization Name:TOWN OF TYNGSBOROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERRARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-649-2300
Mailing Address - Street 1:25 BRYANTS LANE
Mailing Address - Street 2:
Mailing Address - City:TYNGSBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01879
Mailing Address - Country:US
Mailing Address - Phone:978-649-2300
Mailing Address - Fax:978-649-2326
Practice Address - Street 1:25 BRYANTS LANE
Practice Address - Street 2:
Practice Address - City:TYNGSBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01879
Practice Address - Country:US
Practice Address - Phone:978-649-2300
Practice Address - Fax:978-649-2326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF TYNGSBOROUGH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11103Medicare UPIN