Healthcare Provider Details

I. General information

NPI: 1376918540
Provider Name (Legal Business Name): CNS CLINICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST SUITE150
WELLESLEY MA
02481-2118
US

IV. Provider business mailing address

65 WALNUT ST SUITE 150
WELLESLEY MA
02481-2118
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-0070
  • Fax: 781-237-0090
Mailing address:
  • Phone: 781-237-0070
  • Fax: 781-237-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER Q WARINNER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 781-237-0070