Provider Demographics
NPI:1871045815
Name:BOSTON REPRODUCTIVE MEDICINE PHYSICIAN GROUP PPLC
Entity Type:Organization
Organization Name:BOSTON REPRODUCTIVE MEDICINE PHYSICIAN GROUP PPLC
Other - Org Name:CCRM BOSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-449-9750
Mailing Address - Street 1:300 BOYLSTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1959
Mailing Address - Country:US
Mailing Address - Phone:720-873-4174
Mailing Address - Fax:303-781-8158
Practice Address - Street 1:300 BOYLSTON ST STE 300
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1976
Practice Address - Country:US
Practice Address - Phone:617-449-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility FacilityGroup - Single Specialty