Provider Demographics
NPI:1336993575
Name:ELECTRA HEALTH MEDICAL MASS., P.C.
Entity Type:Organization
Organization Name:ELECTRA HEALTH MEDICAL MASS., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-524-8706
Mailing Address - Street 1:228 PARK AVE S PMB 49409
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:202-524-8706
Mailing Address - Fax:
Practice Address - Street 1:84 STATE STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:202-524-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty