Provider Demographics
NPI:1881027746
Name:NEWTON WELLESLEY INTERVENTIONAL SPINE LLC
Entity Type:Organization
Organization Name:NEWTON WELLESLEY INTERVENTIONAL SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:HAMMAM
Authorized Official - Last Name:EL ABD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-308-0300
Mailing Address - Street 1:378 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6207
Mailing Address - Country:US
Mailing Address - Phone:781-489-5541
Mailing Address - Fax:781-489-5340
Practice Address - Street 1:378 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6207
Practice Address - Country:US
Practice Address - Phone:781-489-5541
Practice Address - Fax:781-489-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217195261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty