Healthcare Provider Details

I. General information

NPI: 1972575801
Provider Name (Legal Business Name): IGOR GENE TUROK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MASONIC AVE SUITE 2400
WALLINGFORD CT
06492-3095
US

IV. Provider business mailing address

67 MASONIC AVE SUITE 2400
WALLINGFORD CT
06492-3095
US

V. Phone/Fax

Practice location:
  • Phone: 203-626-9080
  • Fax: 203-626-9074
Mailing address:
  • Phone: 203-626-9080
  • Fax: 203-626-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number237889
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number045712
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number045712
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: