Organization
BOSTON BODY EVOLUTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL NGUYEN MD (AUTHORIZED OFFICIAL)
(617) 396-7899
Entity
Organization
Contact information
Practice address
1290 BOYLSTON STREET, CHESTNUT HILL, MA 02467
(617) 396-7899
(212) 253-4039
Mailing address
1300 BOYLSTON STREET, CHESTNUT, MA 02467
(617) 396-7899
(212) 253-4039
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
245841
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245841
LICENSE
MA
Enumeration date
05/17/2016
Last updated
05/17/2016
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