Healthcare Provider Details

I. General information

NPI: 1053713800
Provider Name (Legal Business Name): CONNECTICUT HEADACHE AND MIGRAINE RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 GLENVILLE RD SUITE 2B
GREENWICH CT
06831-4148
US

IV. Provider business mailing address

235 GLENVILLE RD SUITE 2B
GREENWICH CT
06831-4148
US

V. Phone/Fax

Practice location:
  • Phone: 203-531-5688
  • Fax: 203-531-5663
Mailing address:
  • Phone: 203-531-5688
  • Fax: 203-531-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS ANZALONE
Title or Position: OWNER
Credential:
Phone: 203-531-5688