Provider Demographics
NPI:1134995376
Name:BATISTA, JADER SIQUEIRA SR
Entity type:Individual
Prefix:
First Name:JADER
Middle Name:SIQUEIRA
Last Name:BATISTA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GREENVILLE ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2316
Mailing Address - Country:US
Mailing Address - Phone:617-642-2358
Mailing Address - Fax:
Practice Address - Street 1:102 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4607
Practice Address - Country:US
Practice Address - Phone:617-720-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17698225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist