Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1558408740 |
---|---|
Provider Name | Nicholas P Grigorieff |
First Address | Concord, MA 01742-3313 |
Second Address | Concord, MA 01742-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1531484 | (05) | MA |
30003020 | (05) | NH |
700626 | HARVARD PILGRIM (01) | MA |
96949701 | NETWORK HEALTH (01) | MA |