1962806679 NPI number — NEW SOLUTIONS PAIN MANAGEMENT CLINIC LLC

Table of content: (NPI 1962806679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962806679 NPI number — NEW SOLUTIONS PAIN MANAGEMENT CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW SOLUTIONS PAIN MANAGEMENT CLINIC 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:
1962806679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/08/2023
NPI Reactivation Date:
08/21/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 BOSTON POST ROAD
Provider Second Line Business Mailing Address:
UNIT 1A
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06477-3690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
475-882-6824
Provider Business Mailing Address Fax Number:
203-693-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 BOSTON POST ROAD
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06477-3690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
475-882-6824
Provider Business Practice Location Address Fax Number:
203-693-2320
Provider Enumeration Date:
10/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TESTO
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER AND OWNER
Authorized Official Telephone Number:
475-882-6824

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  004689 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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