Healthcare Provider Details

I. General information

NPI: 1053695098
Provider Name (Legal Business Name): PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 WEST MAIN STREET SUITE 100
STAMFORD CT
06902-4536
US

IV. Provider business mailing address

2015 WEST MAIN STREET SUITE 100
STAMFORD CT
06902-4536
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4588
  • Fax: 203-661-6724
Mailing address:
  • Phone: 203-863-4588
  • Fax: 203-661-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: HALINA SNOWBALL
Title or Position: MD/OWNER
Credential:
Phone: 203-661-9383