Healthcare Provider Details

I. General information

NPI: 1417556317
Provider Name (Legal Business Name): NEW ENGLAND ADVANCED SPINE & PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR STE B202
TRUMBULL CT
06611-6337
US

IV. Provider business mailing address

7 RED MILL LN
DARIEN CT
06820-3612
US

V. Phone/Fax

Practice location:
  • Phone: 203-548-7590
  • Fax: 855-950-0826
Mailing address:
  • Phone: 203-548-7590
  • Fax: 855-950-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BASSEM O ABRAHAM
Title or Position: OWNER
Credential: MD
Phone: 203-548-7590