Healthcare Provider Details

I. General information

NPI: 1639356942
Provider Name (Legal Business Name): PAIN AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTENNIAL DR EAST ENTRANCE
PEABODY MA
01960-7900
US

IV. Provider business mailing address

10 CENTENNIAL DR EAST ENTRANCE
PEABODY MA
01960-7900
US

V. Phone/Fax

Practice location:
  • Phone: 978-826-7230
  • Fax:
Mailing address:
  • Phone: 978-826-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number71164
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number71164
License Number StateMA

VIII. Authorized Official

Name: JULIEN VAISMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 978-826-7230