Provider Demographics
NPI:1457731044
Name:WELLESLEY HYPERBARICS
Entity Type:Organization
Organization Name:WELLESLEY HYPERBARICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-489-5020
Mailing Address - Street 1:978 WORCESTER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3709
Mailing Address - Country:US
Mailing Address - Phone:781-489-5020
Mailing Address - Fax:781-489-5022
Practice Address - Street 1:978 WORCESTER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3709
Practice Address - Country:US
Practice Address - Phone:781-489-5020
Practice Address - Fax:781-489-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty