Healthcare Provider Details

I. General information

NPI: 1508100157
Provider Name (Legal Business Name): GREYSTONE PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ROCKLAND ST UNIT M
CANTON MA
02021
US

IV. Provider business mailing address

21 ROCKLAND ST UNIT M
CANTON MA
02021-5104
US

V. Phone/Fax

Practice location:
  • Phone: 205-266-8811
  • Fax: 205-266-8811
Mailing address:
  • Phone: 205-266-8811
  • Fax: 205-266-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number52005
License Number StateMA

VIII. Authorized Official

Name: DR. ALAA ELREFAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-266-8811