Provider Demographics
NPI:1942385364
Name:CITY OF REVERE
Entity Type:Organization
Organization Name:CITY OF REVERE
Other - Org Name:HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSPECTIONAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CATINAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-286-8176
Mailing Address - Street 1:249R BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:781-286-8176
Mailing Address - Fax:781-485-2795
Practice Address - Street 1:249R BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151
Practice Address - Country:US
Practice Address - Phone:781-286-8176
Practice Address - Fax:781-485-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11116Medicare ID - Type UnspecifiedMEDICARE SUBMITTER ID NUM