Cory J Manhertz
Individual provider Active NPI Contractor · Boston, MA
NPI 1154729341 · NPPES record last updated Dec 20, 2014
Key facts
- NPI
- 1154729341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 193 Hamilton St
Boston, MA 02122-1504 - Phone
- (617) 704-3635
- NPI assigned
- Dec 20, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
193 Hamilton St
Boston, MA 02122-1504
Mailing address
193 Hamilton St
Boston, MA 02122-1504
Phone (617) 704-3635
Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.