Provider Demographics
NPI:1770055030
Name:JOSEPH YERETSIAN, PC
Entity type:Organization
Organization Name:JOSEPH YERETSIAN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YERETSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-507-1472
Mailing Address - Street 1:4770 BASELINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2668
Mailing Address - Country:US
Mailing Address - Phone:720-893-0842
Mailing Address - Fax:617-507-1426
Practice Address - Street 1:1309 BEACON ST STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5252
Practice Address - Country:US
Practice Address - Phone:857-267-8820
Practice Address - Fax:617-507-1426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH YERETSIAN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-27
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty