Provider Demographics
NPI:1821027079
Name:ANGELS NEUROLOGICAL CENTERS PC
Entity Type:Organization
Organization Name:ANGELS NEUROLOGICAL CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEYNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-871-3773
Mailing Address - Street 1:536 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2424
Mailing Address - Country:US
Mailing Address - Phone:781-871-3773
Mailing Address - Fax:
Practice Address - Street 1:536 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351
Practice Address - Country:US
Practice Address - Phone:781-871-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACJ3125OtherRAIL ROAD MEDICARE
MA0017502OtherNEIGHBORHOOD HEALTH
MA682001OtherTUFTS
MA9703471Medicaid
MAM17308OtherBCBS
MAM20893Medicare PIN