Healthcare Provider Details

I. General information

NPI: 1356906572
Provider Name (Legal Business Name): SPECTRUM NEURO BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

V. Phone/Fax

Practice location:
  • Phone: 508-500-6166
  • Fax: 508-500-6167
Mailing address:
  • Phone: 781-666-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FURQUAN ALI SYED
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 508-816-7276