Provider Demographics
NPI:1861864100
Name:NEDAB LLC
Entity Type:Organization
Organization Name:NEDAB LLC
Other - Org Name:NORTHEAST DERMATOLOGY ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-691-5696
Mailing Address - Street 1:401 ANDOVER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5076
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:138 CONANT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1665
Practice Address - Country:US
Practice Address - Phone:978-927-5254
Practice Address - Fax:978-921-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty