Square Knot Professional Services LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

SQUARE KNOT PROFESSIONAL SERVICES LLC

Doing business as

Square Knot Health

Practice address

240 Mount Vernon St
West Newton, MA 02465-2519

Phone

(617) 468-4245

Fax

(617) 468-4556

NPI assigned

Jun 15, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Eliot Charles Heher, MD

Title

President

Phone

(617) 468-4247

Specialties & licenses 1

Addresses

Other names 1

• Square Knot Health Doing business as

Locations

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1619545688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 MOUNT VERNON ST",
            "city": "WEST NEWTON",
            "state": "MA",
            "postal_code": "024652519",
            "telephone_number": "617-468-4245",
            "fax_number": "617-468-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MOUNT VERNON ST",
            "city": "WEST NEWTON",
            "state": "MA",
            "postal_code": "024652519",
            "telephone_number": "617-468-4245",
            "fax_number": "617-468-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE KNOT PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "HEHER",
        "authorized_official_first_name": "ELIOT",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-468-4247",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Square Knot Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Jung Sug Shim, PH.D.
• Tiffany L Simmons
• Susan D Siroty, PSY.D.
• Susan Sklan, LICSW
• Ruth Berniss Smith, PH.D, MSW
• Popi Stamatakos
• Jennifer Abby Stone, PH.D.
• Stonebridge Care Center LLC
• Jeffrey Suriyodorn, PHARMD
• Bruce Swartz, PSY.D.

• Nephrology Physician in West Newton, MA
• Providers in West Newton, MA by specialty
• Nephrology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.