Healthcare Provider Details

I. General information

NPI: 1851771273
Provider Name (Legal Business Name): MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MILL ST STE 201
EAST BERLIN CT
06023-1159
US

IV. Provider business mailing address

1224 MILL ST STE 201
EAST BERLIN CT
06023-1159
US

V. Phone/Fax

Practice location:
  • Phone: 860-570-3400
  • Fax: 860-570-0750
Mailing address:
  • Phone: 860-570-3400
  • Fax: 860-570-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3244
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1799
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number25728
License Number StateCT

VIII. Authorized Official

Name: DR. CHRISTOPHER PETER NORVAL
Title or Position: OWNER
Credential: DC, MS, PA-C
Phone: 860-570-3400