Provider Demographics
NPI:1790730513
Name:GREATER BOSTON ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:GREATER BOSTON ORTHOPAEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:DABUZHSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-376-5656
Mailing Address - Street 1:54 MILLER ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4725
Mailing Address - Country:US
Mailing Address - Phone:617-376-5656
Mailing Address - Fax:617-376-1662
Practice Address - Street 1:54 MILLER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4725
Practice Address - Country:US
Practice Address - Phone:617-376-5656
Practice Address - Fax:617-376-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067083AMedicaid
MAA54994Medicare UPIN
MAM20837Medicare ID - Type Unspecified