Healthcare Provider Details

I. General information

NPI: 1063231181
Provider Name (Legal Business Name): INFUSION BAR & WELLNESS CENTER OF TAUNTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDUSTRIAL PARK ROAD
TAUNTON MA
02780
US

IV. Provider business mailing address

100 INDUSTRIAL PARK ROAD
TAUNTON MA
02780
US

V. Phone/Fax

Practice location:
  • Phone: 508-916-2282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: IGOR YATSKAR
Title or Position: PRESIDENT
Credential:
Phone: 857-222-0522