Basic Information
| Provider Information | |||||||||
| NPI: | 1811128994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLOYAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541095 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 08/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN284103 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.