NPIMap

Organization Active NPI

South Shore Injury Treatment Center

  • Physical Medicine & Rehabilitation Physician
  • Quincy, MA
National Provider Identifier
1922478643
Registry record updated Oct 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
80064 Issued in MA
Legal business name
SOUTH SHORE INJURY TREATMENT CENTER
Practice address
25 School St
B2
Quincy, MA 02169-6607
Phone
(617) 689-0440
Fax
(617) 689-0420
NPI assigned
Oct 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2015

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

Authorized official

Name
Jay A Provenzano
Title
Treasurer
Phone
(617) 689-0440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 80064 MA Primary

Addresses

Primary practice location

25 School St
B2
Quincy, MA 02169-6607

Mailing address

25 School St
B2
Quincy, MA 02169-6607
Phone (617) 689-0440

National Provider Directory

National Provider Directory

Locations

25 School St
Ste B2
Quincy, MA 02169
Phone (617) 689-0440

NPI Registry JSON

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1922478643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 SCHOOL ST",
            "address_2": "B2",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021696607",
            "telephone_number": "617-689-0440",
            "fax_number": "617-689-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 SCHOOL ST",
            "address_2": "B2",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021696607",
            "telephone_number": "617-689-0440",
            "fax_number": "617-689-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE INJURY TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "PROVENZANO",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "617-689-0440"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MA",
            "license": "80064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.