NPIMap

Organization Active NPI

Ally IV & Therapeutics, Inc

  • Nurse Practitioner
  • Boston, MA
National Provider Identifier
1366033102
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ALLY IV & THERAPEUTICS, INC
Practice address
305 Newbury St Ste 41
Boston, MA 02115-2833
Phone
(617) 600-4235
Fax
(617) 600-4235
NPI assigned
Feb 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Mrs. Susan Sserunkuma Wilkinson, NPNPI 1891103958
Title
President/Founder
Phone
(617) 600-4235

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

305 Newbury St Ste 41
Boston, MA 02115-2833

Mailing address

305 Newbury St Ste 41
Boston, MA 02115-2833
Phone (617) 600-4235

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1366033102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 NEWBURY ST STE 41",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021152833",
            "telephone_number": "617-600-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 NEWBURY ST STE 41",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021152833",
            "telephone_number": "617-600-4235",
            "fax_number": "617-600-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLY IV & THERAPEUTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-01-30",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "SSERUNKUMA",
        "authorized_official_title_or_position": "PRESIDENT/FOUNDER",
        "authorized_official_telephone_number": "617-600-4235",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.