Provider Demographics
NPI:1972648467
Name:NEW ENGLAND PODIATRY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NEW ENGLAND PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ETSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-232-1752
Mailing Address - Street 1:1244 BOYLSTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2115
Mailing Address - Country:US
Mailing Address - Phone:617-232-1752
Mailing Address - Fax:
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-232-1752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1948213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9740333Medicaid
MA9740333Medicaid