Healthcare Provider Details

I. General information

NPI: 1316275241
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY AND PAIN CENTER OF CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
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 TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number045712
License Number StateCT

VIII. Authorized Official

Name: DR. IGOR TUROK
Title or Position: SOLE OWNER OF LLC
Credential: MD
Phone: 203-626-9080