Healthcare Provider Details

I. General information

NPI: 1851932016
Provider Name (Legal Business Name): ADVANCED WELLNESS AND MUSCULOSKELETAL PAIN CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 SUMMER ST STE 1
STAMFORD CT
06901-1407
US

IV. Provider business mailing address

595 SUMMER ST STE 1
STAMFORD CT
06901-1407
US

V. Phone/Fax

Practice location:
  • Phone: 203-998-7688
  • Fax: 475-333-0511
Mailing address:
  • Phone: 203-998-7688
  • Fax: 475-333-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIN P TSOI
Title or Position: PRESIDENT
Credential: MD
Phone: 917-603-2993