Provider Demographics
NPI:1649059932
Name:ORTHOBIOLOGICS ASSOCIATES BOSTON LLC
Entity type:Organization
Organization Name:ORTHOBIOLOGICS ASSOCIATES BOSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-415-3200
Mailing Address - Street 1:5311 SPRING HILL DR.
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4558
Mailing Address - Country:US
Mailing Address - Phone:352-415-3200
Mailing Address - Fax:352-398-1233
Practice Address - Street 1:1110 WASHINGTON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-9998
Practice Address - Country:US
Practice Address - Phone:352-415-3200
Practice Address - Fax:727-286-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty