Mystic Valley Urological Assoc Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

MYSTIC VALLEY UROLOGICAL ASSOC INC

Practice address

3 Woodland Rd
Suite 216
Stoneham, MA 02180-1702

Phone

(781) 979-0661

Fax

(781) 979-0372

NPI assigned

Dec 17, 2009

Organization subpart

No

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

Authorized official

Name

Marjie Haluska

Title

Director of Business Operations

Phone

(781) 979-0661

Specialties & licenses 1

Addresses

Other identifiers 8

Tax ID family

Mystic Valley Urologica2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mystic Valley Urological Associates, Inc

  • Urology Physician
  • Stoneham, MA
  • NPI 1114452547
  NPD tax ID

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1689903882",
    "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 ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "HALUSKA",
        "authorized_official_first_name": "MARJIE",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "781-979-0661"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP",
            "identifier": "0009638",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9723757",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "M13568",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "M13568",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "9723757",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "28749",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "600296",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMED",
            "identifier": "CL0638",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A. Muise, PT, DPT
• Erin P Murphy, N.P.
• Nicholas Musto
• Mystic Valley Dermatology Associates, P.C.
• Mystic Valley Mass, PC
• Mystic Valley Urological Associates Inc.
• Mystic Valley Urological Associates, Inc
• XI NA, M.D., PH.D.
• Kanta Nagpaul, M.D.
• Jane Namatovu

• Urology Physician in Stoneham, MA
• Providers in Stoneham, MA by specialty
• Urology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; 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.