Healthcare Provider Details

I. General information

NPI: 1265730162
Provider Name (Legal Business Name): NEW ENGLAND PAIN ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND ST STE 2B
WOONSOCKET RI
02895-3327
US

IV. Provider business mailing address

10 CONVERSE PL STE 4 10 CONVERSE PLACE 4TH FLOOR
WINCHESTER MA
01890-2713
US

V. Phone/Fax

Practice location:
  • Phone: 617-548-5959
  • Fax:
Mailing address:
  • Phone: 401-356-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number152670
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number152670
License Number StateMA

VIII. Authorized Official

Name: DR. FATHALLA MASHALI
Title or Position: PRESIDENT
Credential:
Phone: 617-548-5959