Provider Demographics
NPI:1942819172
Name:NEV BURLINGTON LLC
Entity Type:Organization
Organization Name:NEV BURLINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER / OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:781-910-5555
Mailing Address - Street 1:19 PITMAN DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1959
Mailing Address - Country:US
Mailing Address - Phone:781-910-5555
Mailing Address - Fax:
Practice Address - Street 1:101 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4934
Practice Address - Country:US
Practice Address - Phone:781-270-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies