Provider Demographics
NPI:1811434491
Name:ANIKET CHAKRABARTI
Entity type:Organization
Organization Name:ANIKET CHAKRABARTI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIKET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABARTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-826-3838
Mailing Address - Street 1:243 CHURCH ST STE E
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1962
Mailing Address - Country:US
Mailing Address - Phone:781-826-3838
Mailing Address - Fax:781-826-3846
Practice Address - Street 1:243 CHURCH ST STE E
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1962
Practice Address - Country:US
Practice Address - Phone:781-826-3838
Practice Address - Fax:781-826-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157637310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility