Provider Demographics
NPI:1881606903
Name:BROOKLINE ASSOCIATES IN INTERNAL MEDICINE,PC
Entity type:Organization
Organization Name:BROOKLINE ASSOCIATES IN INTERNAL MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HURVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-782-9210
Mailing Address - Street 1:11 NEVINS ST
Mailing Address - Street 2:505
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-782-9210
Mailing Address - Fax:617-782-8565
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:505
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-782-9210
Practice Address - Fax:617-782-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9723731Medicaid
MA9723731Medicaid