1780819300 NPI number — NEW ENGLAND PAIN ASSOCIATES, PC

Table of content: (NPI 1780819300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780819300 NPI number — NEW ENGLAND PAIN ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND PAIN ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780819300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CONVERSE PL
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01890-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-729-0500
Provider Business Mailing Address Fax Number:
781-729-0581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 WOOD RD
Provider Second Line Business Practice Location Address:
STE. 204
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-843-5700
Provider Business Practice Location Address Fax Number:
781-843-5721
Provider Enumeration Date:
05/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MASHALI
Authorized Official First Name:
FATHALLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-843-5700

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9751921 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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