Provider Demographics
NPI:1447376017
Name:NORTHEAST FOOT & ANKLE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:NORTHEAST FOOT & ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-640-1010
Mailing Address - Street 1:1565 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4735
Mailing Address - Country:US
Mailing Address - Phone:978-640-1010
Mailing Address - Fax:978-640-9444
Practice Address - Street 1:1565 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4735
Practice Address - Country:US
Practice Address - Phone:978-640-1010
Practice Address - Fax:978-640-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2042213E00000X
NH0308213E00000X
MA1432213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA480030479OtherRAILROAD MEDICARE
MA1215040001Medicare NSC
MAU61532Medicare UPIN
MAY78028Medicare PIN
MAY70567Medicare PIN
MAT58660Medicare UPIN
MAY75022Medicare PIN