Healthcare Provider Details

I. General information

NPI: 1336333640
Provider Name (Legal Business Name): NEW ENGLAND PAIN ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 520
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

42 HEMINGWAY DR.
E. PROVIDENCE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-9336
  • Fax: 508-363-5959
Mailing address:
  • Phone: 401-490-2130
  • Fax: 401-435-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier90934
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON
# 2
Identifier909529
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHPHC
# 3
IdentifierM88041
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS MA

VIII. Authorized Official

Name: FATHALLA MASHALI
Title or Position: PRESIDENT
Credential: MD
Phone: 401-490-2130