Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 257277 | MA |
N | 111NI0900X | Internist | 257277 | MA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 257277 | MA |
NPI | 1013342518 |
---|---|
Provider Name | Mr. Jeremy Kobulnik |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 23/05/2014 |