Organization
EAST BAY NEUROLOGY PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOTASEM A AL YACOUB MD (PRESIDENT)
(401) 724-4100
Entity
Organization
Contact information
Practice address
333 SCHOOL ST STE 216, PAWTUCKET, RI 02860
(401) 722-7300
(401) 722-7390
Mailing address
333 SCHOOL ST STE 216, PAWTUCKET, RI 02860-5336
(401) 722-7300
(401) 722-7390
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PS00999
RI
2084N0400X
Neurology Physician
212368
MA
2084N0400X
Neurology Physician
Primary
MD 09501
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006029
—
RI
Enumeration date
02/22/2007
Last updated
06/20/2018
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