Healthcare Provider Details

I. General information

NPI: 1174155642
Provider Name (Legal Business Name): PAIN MANAGEMENT PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 06/16/2022
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KENT RD STE 201
NEW MILFORD CT
06776-3489
US

IV. Provider business mailing address

7 OLD SHERMAN TPKE STE 209
DANBURY CT
06810-4174
US

V. Phone/Fax

Practice location:
  • Phone: 860-717-2676
  • Fax: 860-717-2675
Mailing address:
  • Phone: 203-885-1441
  • Fax: 475-329-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN SPRAGUE
Title or Position: PRACTICE MANAGER
Credential: DO
Phone: 203-885-1441