Healthcare Provider Details

I. General information

NPI: 1447161393
Provider Name (Legal Business Name): AVICENNA HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NORTH ST
FOXBORO MA
02035-1353
US

IV. Provider business mailing address

43 NORTH ST
FOXBORO MA
02035-1353
US

V. Phone/Fax

Practice location:
  • Phone: 972-795-3422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AZIM NASIR
Title or Position: PARTNER
Credential:
Phone: 972-795-3422