Provider Demographics
NPI:1942376009
Name:VEIN AND LASER CENTER OF NEW ENGLAND PC
Entity Type:Organization
Organization Name:VEIN AND LASER CENTER OF NEW ENGLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SEMATONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-747-1333
Mailing Address - Street 1:45 RESNIK ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-747-1333
Mailing Address - Fax:508-747-2850
Practice Address - Street 1:45 RESNIK ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-747-1333
Practice Address - Fax:508-747-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9264381Medicaid
715157OtherTUFTS
J20063OtherBCBS
A59409Medicare UPIN
M21732Medicare ID - Type Unspecified