Basic Information
| Provider Information | |||||||||
| NPI: | 1104086107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMAHIYEROBO | ||||||||
| FirstName: | JOYCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 254815 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 1104086107 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 042297845 | 01 | UNITED HEALTH CARE | OTHER | 5792931 | 01 | AETNA | OTHER | AA330484 | 01 | HARVARD PILGRIM | OTHER | 1104086107 | 01 | TUFTS AND TMP | OTHER | 5860263 | 01 | CIGNA | OTHER | J52294 | 01 | MA | BCBSMA | OTHER | 042297845 | 01 | MULTI-PLAN/PHCS | OTHER | 042297845 | 01 | TRICARE | OTHER | 042297845 | 01 | UNICARE | OTHER | 1104086107 | 01 | FALLON | OTHER | 9237950 | 01 | NETWORK HEALTH | OTHER |