Organization
NORTHEAST ENT, INC
Active
Organization
NORTHEAST ENT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA J MOTTA (ADMINISTRATOR)
(508) 995-0700
Entity
Organization
Contact information
Practice address
300A FAUNCE CORNER RD, SUITE 102, N DARTMOUTH, MA 02747-1280
(508) 995-0700
(508) 995-3070
Mailing address
300A FAUNCE CORNER RD, SUITE 102, N DARTMOUTH, MA 02747-1280
(508) 995-0700
(508) 995-3070
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4517
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36162
HARVARD PILGRIM
—
01
—
SP0029
BLUE CROSS BLUE SHIELD MA
—
Enumeration date
12/04/2007
Last updated
12/04/2007
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