Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 6761 | MA |
NPI | 1528060118 |
---|---|
Provider Name | Mr. Joseph S O Connor |
First Address | Lynn, MA 01901-1011 |
Second Address | Peabody, MA 01960-1670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001270 | NEIGHBORHOOD HLTH (01) | MA |
0365106 | (05) | MA |
2049990 | AETNA (01) | MA |
2153514 | FIRST HEALTH (01) | |
540790 | CIGNA HEALTH SOURCE (01) | MA |
612043 | TUFTS (01) | MA |
626117 | HCHP (01) | MA |
64 00088 | UNITED HEALTH (01) | MA |
766575 | BCBS (01) | MA |
Y61243 | BCBS GROUP (01) | MA |