NPIMap

Organization Active NPI

Boston Spine Teaching and Research Foundation Inc.

  • Orthopaedic Surgery of the Spine Physician
  • Newton, MA
National Provider Identifier
1225083579
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
59668 Issued in MA
Legal business name
BOSTON SPINE TEACHING AND RESEARCH FOUNDATION INC.
Practice address
299 Washington Street
Newton, MA 02458-1612
Phone
(617) 219-6300
Fax
(617) 219-6366
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Robert Jude Banco, M.D.
Title
Executive Director
Phone
(617) 219-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0117X 59668 MA Primary

Addresses

Primary practice location

299 Washington Street
Newton, MA 02458-1612

Mailing address

P.O. Box 4110
Department 3110
Woburn, MA 01888-4110
Phone (781) 619-0173

Other identifiers 1

IdentifierTypeStateIssuer
M19066OtherMABCBS MA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1225083579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4110",
            "address_2": "DEPARTMENT 3110",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018884110",
            "telephone_number": "781-619-0173",
            "fax_number": "781-551-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 WASHINGTON STREET",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024581612",
            "telephone_number": "617-219-6300",
            "fax_number": "617-219-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON SPINE TEACHING AND RESEARCH FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "BANCO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "617-219-6300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MA",
            "license": "59668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "M19066",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.