Individual
MR. JOHN D FAVORITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
35 LACKEY ST, WESTBOROUGH, MA 01581-3207
(508) 579-4686
Mailing address
35 LACKEY ST, WESTBOROUGH, MA 01581-3207
(508) 579-4686
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
130991
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0711551
PROVIDER NUMBER
MA
Enumeration date
04/24/2007
Last updated
07/08/2007
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