1851771273 NPI number — MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC

Table of content: (NPI 1851771273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851771273 NPI number — MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MULTICARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851771273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1224 MILL ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BERLIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06023-1159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-570-3400
Provider Business Mailing Address Fax Number:
860-570-0750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 MILL ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERLIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06023-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-570-3400
Provider Business Practice Location Address Fax Number:
860-570-0750
Provider Enumeration Date:
06/01/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NORVAL
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-570-3400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1799 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: 25728 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 3244 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)