Healthcare Provider Details

I. General information

NPI: 1316981780
Provider Name (Legal Business Name): MOMEN M ELNESR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 VERNON ST STE 302
WORCESTER MA
01610-1989
US

IV. Provider business mailing address

95 VERNON ST STE 302
WORCESTER MA
01610-1989
US

V. Phone/Fax

Practice location:
  • Phone: 508-757-1514
  • Fax: 508-757-1584
Mailing address:
  • Phone: 508-757-1514
  • Fax: 508-757-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number13957
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number158266
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number158266
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13957
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: