Provider Demographics
NPI:1144450081
Name:THE BOSTON SPINE GROUP LLC
Entity type:Organization
Organization Name:THE BOSTON SPINE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-219-6300
Mailing Address - Street 1:299 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1612
Mailing Address - Country:US
Mailing Address - Phone:617-219-6300
Mailing Address - Fax:
Practice Address - Street 1:32 NEWTON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHBORO
Practice Address - State:MA
Practice Address - Zip Code:01772-1215
Practice Address - Country:US
Practice Address - Phone:508-460-3800
Practice Address - Fax:508-787-9872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BOSTON SPINE GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty