Provider Demographics
NPI:1871637298
Name:JUDITH FINE/DBA/ GAZEBO
Entity Type:Organization
Organization Name:JUDITH FINE/DBA/ GAZEBO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:I
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-584-6673
Mailing Address - Street 1:14 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3005
Mailing Address - Country:US
Mailing Address - Phone:413-584-6673
Mailing Address - Fax:413-584-0195
Practice Address - Street 1:14 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3005
Practice Address - Country:US
Practice Address - Phone:413-584-6673
Practice Address - Fax:413-584-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703215OtherHARVARD PILGRIM PROVIDER
MA393054OtherBLUE CROSS PROVIDER NUMBE
MA12562OtherHEALTH NEW ENGLAND PROVID
MA805533OtherTUFTS PROVIDER NUMBER
MA0922110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER