Provider Demographics
NPI:1649358193
Name:BOSTON PODIATRY SERVICES PC
Entity type:Organization
Organization Name:BOSTON PODIATRY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-878-4517
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:28 PACIFIC ST
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370
Mailing Address - Country:US
Mailing Address - Phone:781-878-4517
Mailing Address - Fax:781-878-9378
Practice Address - Street 1:28 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370
Practice Address - Country:US
Practice Address - Phone:781-878-4517
Practice Address - Fax:781-878-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1529213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
712279OtherTUFTS
MA339792Medicaid
333445OtherHARVARD PILGRIM
Y70676OtherBLUE CROSS
MA6315130001Medicare NSC
T79884Medicare UPIN
MA339792Medicaid