| Organization Name: | HAVEN MEDICAL GROUP, LLC, PC |
| NPI Number: | 1710369368 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANJAY BASU (CEO) |
| Mailing Address: | 200 Groton Rd Department Of Addiction Medicine Ayer |
| State: | MA US |
| Postal Code: | 014321168 |
| Phone Number: | 6176469912 |
| Fax Number: | |
| NPI Enumeration Date: | 06/19/2015 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |