NPIMap

Organization Active NPI

Mystic Valley Urological Associates, Inc

  • Urology Physician
  • Stoneham, MA
National Provider Identifier
1114452547
Registry record updated Apr 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MYSTIC VALLEY UROLOGICAL ASSOCIATES, INC
Practice address
3 Woodland Rd
Suite 216
Stoneham, MA 02180-1702
Phone
(781) 979-0661
Fax
(781) 979-0372
NPI assigned
Apr 24, 2017
Organization subpart
Yes
Parent organization
MYSTIC VALLEY UROLOGICAL ASSOCIATES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marjie C Haluska
Title
Director of Business Operations
Phone
(781) 462-3040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

3 Woodland Rd
Suite 216
Stoneham, MA 02180-1702

Mailing address

3 Woodland Rd
Suite 216
Stoneham, MA 02180-1702
Phone (781) 979-0661

Other names 1

  • Mystic Valley Urological Associates, Too Other name

National Provider Directory

National Provider Directory
Tax ID family
Mystic Valley Urologica2 organizations share this tax ID, including this one
Part of
Mystic Valley Urologica

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1114452547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WOODLAND RD",
            "address_2": "SUITE 216",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021801702",
            "telephone_number": "781-979-0661",
            "fax_number": "781-979-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 WOODLAND RD",
            "address_2": "SUITE 216",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021801702",
            "telephone_number": "781-979-0661",
            "fax_number": "781-979-0372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC VALLEY UROLOGICAL ASSOCIATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYSTIC VALLEY UROLOGICAL ASSOCIATES, INC",
        "enumeration_date": "2017-04-24",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "HALUSKA",
        "authorized_official_first_name": "MARJIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "781-462-3040"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mystic Valley Urological Associates, Too",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.