Provider Demographics
NPI:1730810987
Name:BOSTON SPECIALISTS - SOUTH SHORE LLC
Entity type:Organization
Organization Name:BOSTON SPECIALISTS - SOUTH SHORE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-846-4910
Mailing Address - Street 1:1 NASSAU ST UNIT 1906
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1587
Mailing Address - Country:US
Mailing Address - Phone:617-804-6767
Mailing Address - Fax:877-726-8492
Practice Address - Street 1:75 KNEELAND ST FL 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1901
Practice Address - Country:US
Practice Address - Phone:617-804-6767
Practice Address - Fax:877-726-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty