Provider Demographics
NPI:1619419082
Name:THE PRACTICE OB/GYN PC
Entity Type:Organization
Organization Name:THE PRACTICE OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOULAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-458-8855
Mailing Address - Street 1:60 EAST ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4547
Mailing Address - Country:US
Mailing Address - Phone:978-458-8855
Mailing Address - Fax:978-458-8866
Practice Address - Street 1:60 EAST ST STE 1100
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4547
Practice Address - Country:US
Practice Address - Phone:978-458-8855
Practice Address - Fax:978-458-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119473AMedicaid
MAS100357282OtherMEDICARE ID