Provider Demographics
NPI:1982238192
Name:BOSTON REPRODUCTIVE MEDICINE PHYSICIAN GROUP PPLC
Entity Type:Organization
Organization Name:BOSTON REPRODUCTIVE MEDICINE PHYSICIAN GROUP PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-499-9750
Mailing Address - Street 1:300 BOYLSTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1976
Mailing Address - Country:US
Mailing Address - Phone:617-449-9750
Mailing Address - Fax:
Practice Address - Street 1:300 BOYLSTON ST STE 300
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1976
Practice Address - Country:US
Practice Address - Phone:617-449-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
6512OtherAAAASF