Provider Demographics
NPI:1639356942
Name:PAIN AND WELLNESS CENTER
Entity type:Organization
Organization Name:PAIN AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-826-7230
Mailing Address - Street 1:10 CENTENNIAL DR
Mailing Address - Street 2:EAST ENTRANCE
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7900
Mailing Address - Country:US
Mailing Address - Phone:978-826-7230
Mailing Address - Fax:
Practice Address - Street 1:10 CENTENNIAL DR
Practice Address - Street 2:EAST ENTRANCE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7900
Practice Address - Country:US
Practice Address - Phone:978-826-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71164332B00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17785OtherBCBC GROUP NUMBER
MAM20326OtherMEDICARE GROUP NUMBER