East Bay Neurology Professional Corporation

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD 09501 Issued in RI

Legal business name

EAST BAY NEUROLOGY PROFESSIONAL CORPORATION

Practice address

333 School St Ste 216
Pawtucket, RI 02860

Phone

(401) 722-7300

Fax

(401) 722-7390

NPI assigned

Feb 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Motasem A Al Yacoub, MDNPI 1609837707

Title

President

Phone

(401) 724-4100

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Motasem A Al-Yacoub, M.D.

  • Neurology Physician
  • Pawtucket, RI
  • NPI 1609837707
  Medicare reassignment Care Compare group Authorized official
• Laura Lynnette Frakey, PH.D.

  • Clinical Neuropsychologist
  • Pawtucket, RI
  • NPI 1720260805
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1275668006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 SCHOOL ST STE 216",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605336",
            "telephone_number": "401-722-7300",
            "fax_number": "401-722-7390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SCHOOL ST STE 216",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "02860",
            "telephone_number": "401-722-7300",
            "fax_number": "401-722-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY NEUROLOGY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "AL YACOUB",
        "authorized_official_first_name": "MOTASEM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-724-4100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "RI",
            "license": "PS00999",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "MD 09501",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "212368",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006029",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bianca Ann Dutra
• Sylvie Duverseau, LCSW
• Mari-Beth Dziadosz
• Walter Matthew Dzialo, D.D.S.
• East Bay Counsling Center, Inc..
• East Side Surgical Group Inc
• Eastern Star EMS (Eastern Star)
• Charles B. Eaton, MD
• John Echeverry, BACHELORS
• Edward U Choi MD Inc

• Neurology Physician in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Neurology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.