NPI |
1558149203 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Entity Type Code |
1 |
The country code in the location address of the provider being identified. |
Provider Last Name Legal Name |
POTSURAY |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
KARINA |
The fax number associated with the location
address of the provider being identified. |
Provider First Line Business Practice Location Address |
1600 BOSTON RD |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address City Name |
SPRINGFIELD |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
011291141 |
The first name of the authorized official. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4135435428 |
The 10-position telephone number of the authorized official. |
Provider Enumeration Date |
9/14/2023 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Last Update Date |
9/14/2023 |
|
Provider Gender Code |
F |
|
Healthcare Provider Taxonomy Code 1 |
183500000X |
|
Provider License Number 1 |
PH997037 |
|
Provider License Number State Code 1 |
MA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
9/14/2023 |
|