=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619419082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PRACTICE OB/GYN PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 03/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 EAST ST STE 1100
-----------------------------------------------------
City | METHUEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01844-4547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-458-8855
-----------------------------------------------------
Fax | 978-458-8866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 EAST ST STE 1100
-----------------------------------------------------
City | METHUEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01844-4547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-458-8855
-----------------------------------------------------
Fax | 978-458-8866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. IBRAHIM JOULAK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 978-458-8855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------