Healthcare Provider Details

I. General information

NPI: 1346427325
Provider Name (Legal Business Name): NEW ENGLAND PAIN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JOHN CUMMINGS WAY 2ND FLOOR
WOONSOCKET RI
02895
US

IV. Provider business mailing address

42 HEMINGWAY DRIVE
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-2525
  • Fax: 401-767-2515
Mailing address:
  • Phone: 401-490-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPHS0007
License Number StateRI

VIII. Authorized Official

Name: FATHALLA MASHALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-490-2130