Provider Demographics
NPI:1730950478
Name:BOBROVSKII, SEMEN (HIS)
Entity type:Individual
Prefix:
First Name:SEMEN
Middle Name:
Last Name:BOBROVSKII
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RIVER ST
Mailing Address - Street 2:STORE #12
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-893-8444
Mailing Address - Fax:781-207-2696
Practice Address - Street 1:85 RIVER ST
Practice Address - Street 2:STORE #12
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-893-8444
Practice Address - Fax:781-207-2696
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000490237700000X
MAHES6545237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist