1891262481 NPI number — PAIN & SPINE SPECIALISTS OF CONNECTICUT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891262481 NPI number — PAIN & SPINE SPECIALISTS OF CONNECTICUT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN & SPINE SPECIALISTS OF CONNECTICUT, LLC
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:
Provider Other Organization Name Type Code:
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:
1891262481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD
Provider Second Line Business Mailing Address:
EXECUTIVE PLAZA 1, SUITE 501
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-329-1071
Provider Business Mailing Address Fax Number:
410-329-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 SAND PIT RD STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-743-7264
Provider Business Practice Location Address Fax Number:
203-792-3920
Provider Enumeration Date:
11/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LEVI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
203-792-7246

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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