Organization
NE GASTRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAURICE B COHEN M.D. (PRESIDENT)
(603) 898-5082
Entity
Organization
Contact information
Practice address
52 STILES RD, SUITE 110, SALEM, NH 03079-4879
(603) 898-5082
(603) 890-5453
Mailing address
17 HEARTHSTONE PL, ANDOVER, MA 01810-5422
(603) 898-5082
(603) 890-5453
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
11071
NH
207RG0100X
Gastroenterology Physician
16572
NH
207RG0100X
Gastroenterology Physician
207022
MA
207RG0100X
Gastroenterology Physician
242931
MA
207RG0100X
Gastroenterology Physician
Primary
60421
MA
207RG0100X
Gastroenterology Physician
9119
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110072718A
—
MA
05
—
30214587
—
NH
Enumeration date
05/10/2016
Last updated
05/10/2016
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