Provider Demographics
NPI:1750868600
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT COMMISSIONER OF COMMUNITY
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-204-3690
Mailing Address - Street 1:600 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1704
Mailing Address - Country:US
Mailing Address - Phone:617-204-3600
Mailing Address - Fax:617-727-1354
Practice Address - Street 1:600 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1704
Practice Address - Country:US
Practice Address - Phone:617-204-3600
Practice Address - Fax:617-727-1354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare