Provider Demographics
NPI:1356704142
Name:NEW ENGLAND FITNESS
Entity type:Organization
Organization Name:NEW ENGLAND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BEAUCAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-373-0907
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-0225
Mailing Address - Country:US
Mailing Address - Phone:207-373-0907
Mailing Address - Fax:
Practice Address - Street 1:49 TOPSHAM FAIR MALL RD STE 25
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1735
Practice Address - Country:US
Practice Address - Phone:207-373-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty