Provider Demographics
NPI:1922155522
Name:BOSTON NEUROBEHAVIORAL ASSOCIATES
Entity Type:Organization
Organization Name:BOSTON NEUROBEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-461-0800
Mailing Address - Street 1:80 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1765
Mailing Address - Country:US
Mailing Address - Phone:781-461-0800
Mailing Address - Fax:781-789-0240
Practice Address - Street 1:80 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1765
Practice Address - Country:US
Practice Address - Phone:781-461-0800
Practice Address - Fax:781-789-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20577Medicare ID - Type Unspecified