Provider Demographics
NPI:1457716433
Name:BOSTON PHYSIATRY LLC
Entity Type:Organization
Organization Name:BOSTON PHYSIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MOSTOUFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-547-7163
Mailing Address - Street 1:799 CONCORD AVE
Mailing Address - Street 2:1ST FLOOR, SPINE CENTER
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1048
Mailing Address - Country:US
Mailing Address - Phone:617-547-7163
Mailing Address - Fax:617-547-7165
Practice Address - Street 1:799 CONCORD AVE
Practice Address - Street 2:1ST FLOOR, SPINE CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1048
Practice Address - Country:US
Practice Address - Phone:617-547-7163
Practice Address - Fax:617-547-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty