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General NPI Number Information
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NPI Number | 1881027746
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Entity Type | Organization
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Legal Business Name | NEWTON WELLESLEY INTERVENTIONAL SPINE LLC
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 378 WASHINGTON ST
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City | WELLESLEY
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State | MA
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Zip | 02481-6207
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Country | US
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Telephone | 781-489-5541
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Fax | 781-489-5340
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Provider Business Mailing Address
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Address Line | 378 WASHINGTON ST
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City | WELLESLEY
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State | MA
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Zip | 02481-6207
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Country | US
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Telephone | 781-489-5541
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Fax | 781-489-5340
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Authorized Official
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Title or Position | OWNER
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Name | DR. OMAR HAMMAM EL ABD
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Credential | M.D.
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Telephone | 781-308-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 217195
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License Number State | MA
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