Organization
NORTHEAST PHO, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY BAZYLEWICZ M.D. (PRESIDENT)
(978) 236-1744
Entity
Organization
Contact information
Practice address
55 TOZER RD, BEVERLY, MA 01915-5515
(978) 236-1744
(978) 236-1777
Mailing address
55 TOZER RD, BEVERLY, MA 01915-5515
(978) 236-1744
(978) 236-1777
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
609238
TUFTS HEALTH PLAN
MA
01
—
M19283
BLUE CROSS BLUE SHIELD
MA
Enumeration date
06/08/2007
Last updated
08/22/2020
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