Provider Demographics
NPI:1881189249
Name:NEW SELF CORPORATION
Entity Type:Organization
Organization Name:NEW SELF CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-462-1555
Mailing Address - Street 1:21 HIGHLAND AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3873
Mailing Address - Country:US
Mailing Address - Phone:978-462-1555
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3873
Practice Address - Country:US
Practice Address - Phone:978-462-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty