EAST BAY NEUROLOGY PROFESSIONAL CORPORATION NPI 1275668006

NPI Information

NPI: 1275668006
Provider Name: EAST BAY NEUROLOGY PROFESSIONAL CORPORATION
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

Address:
333 SCHOOL ST STE 216
PAWTUCKET, RI
ZIP 02860
Phone: (401) 722-7300
Get Directions

EAST BAY NEUROLOGY PROFESSIONAL CORPORATION is a neurology psychiatry neurology in Pawtucket, RI. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. EAST BAY NEUROLOGY PROFESSIONAL CORPORATION NPI is 1275668006. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

333 SCHOOL ST STE 216
PAWTUCKET, RI
ZIP 02860
Phone: (401) 722-7300
Fax: (401) 722-7390

The provider's authorized official is Motasem A Al Yacoub .
The authorized official title is President and has the following contact phone number (401) 724-4100.

The enumeration date for this NPI number is 2/22/2007 and was last updated on 6/20/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103G00000X	Clinical Neuropsychologist		PS00999	RHODE ISLAND	No
2	2084N0400X	Psychiatry & Neurology	Neurology	212368	MASSACHUSETTS	No
3	2084N0400X	Psychiatry & Neurology	Neurology	MD 09501	RHODE ISLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7006029	MEDICAID	RHODE ISLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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