Provider Demographics
NPI:1790917946
Name:TOWN OF NEEDHAM
Entity Type:Organization
Organization Name:TOWN OF NEEDHAM
Other - Org Name:NEEDHAM HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD OF HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-449-6878
Mailing Address - Street 1:1471 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2605
Mailing Address - Country:US
Mailing Address - Phone:781-455-7523
Mailing Address - Fax:781-455-0892
Practice Address - Street 1:1471 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2605
Practice Address - Country:US
Practice Address - Phone:781-455-7523
Practice Address - Fax:781-455-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42913251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA046001238OtherDEPARTMENT OF REVENUE