Healthcare Provider Details

I. General information

NPI: 1710313945
Provider Name (Legal Business Name): OCEAN STATE WELLNESS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CASS AVE
WOONSOCKET RI
02895-4712
US

IV. Provider business mailing address

PO BOX 2099
WOONSOCKET RI
02895-0950
US

V. Phone/Fax

Practice location:
  • Phone: 401-597-5897
  • Fax: 401-597-0122
Mailing address:
  • Phone: 401-597-5897
  • Fax: 401-597-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDUL R. BARAKAT
Title or Position: OWNER
Credential: MD
Phone: 401-597-5897