| The Longfellow Club | |
|
524 Boston Post Rd The Longfellow Club Wayland MA 01778-1833 | |
| (508) 358-7355 | |
| (508) 358-3525 |
| Full Name | The Longfellow Club |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 524 Boston Post Rd, Wayland, Massachusetts |
| Authorized Official Name and Position | Jane Polley (DIETITIAN) |
| Authorized Official Contact | 5083587355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Longfellow Club 524 Boston Post Rd The Longfellow Club Wayland MA 01778-1833 Ph: (508) 358-7355 | The Longfellow Club 524 Boston Post Rd The Longfellow Club Wayland MA 01778-1833 Ph: (508) 358-7355 |
| NPI Number | 1003981903 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 06/09/2015 |
| Medicare PECOS PAC ID | 9234229253 |
|---|---|
| Medicare Enrollment ID | O20071214000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003981903 | NPI | - | NPPES |
| 763282 | Other | MA | TUFTS |
| LG0023 | Other | MA | BLUE CROSS BLUE SHIELD |
| 5582051 | Other | MA | AETNA |
| 6300209 | Other | MA | UNITED HEALTH CARE |
| 39411 | Other | MA | HARVARD PILGRIM HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
| Provider Name | Jane F Polley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1124192505 PECOS PAC ID: 1052356201 Enrollment ID: I20050628000406 |
| Provider Name | Janna Yamron |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1093901563 PECOS PAC ID: 0042300071 Enrollment ID: I20071214000209 |
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