Provider Demographics
NPI:1548558075
Name:STEPHEN R ABRAMOWITZ DDSPC
Entity type:Organization
Organization Name:STEPHEN R ABRAMOWITZ DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-471-0394
Mailing Address - Street 1:14 ALLEYNE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2016
Mailing Address - Country:US
Mailing Address - Phone:617-471-0394
Mailing Address - Fax:
Practice Address - Street 1:14 ALLEYNE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-2016
Practice Address - Country:US
Practice Address - Phone:617-471-0394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN R. ABRAMOWITZ DDSPC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306977897Medicare NSC