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Organization

PEDIATRIC HOUSE CALL PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. IGOR STAVITSKY MD (OWNER)
(617) 916-5085
Entity
Organization

Contact information

Practice address
56 WINCHESTER ST STE 5, NEWTON, MA 02461-1730
(617) 916-5085
(617) 916-5105
Mailing address
56 WINCHESTER ST STE 5, NEWTON, MA 02461-1730
(617) 916-5085
(617) 916-5105

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
77664
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3154882
MA
05
A292941
MA
Enumeration date
03/26/2006
Last updated
04/29/2009
About Stedi
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  • EDI platform