Provider Demographics
NPI:1265730162
Name:NEW ENGLAND PAIN ASSOCIATES, PC
Entity type:Organization
Organization Name:NEW ENGLAND PAIN ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATHALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-548-5959
Mailing Address - Street 1:10 CONVERSE PL STE 4
Mailing Address - Street 2:10 CONVERSE PLACE 4TH FLOOR
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2713
Mailing Address - Country:US
Mailing Address - Phone:401-356-4260
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND ST STE 2B
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3327
Practice Address - Country:US
Practice Address - Phone:617-548-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152670261QP3300X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21688Medicare PIN
RI709004505Medicare PIN