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General NPI Number Information
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NPI Number | 1093916546
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERVENTIONAL PAIN MANAGEMENT, P.C.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 2080 BRIDGEPORT AVE STE C
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 203-876-8854
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Fax | 203-876-2626
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Provider Business Mailing Address
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Address Line | PO BOX 264
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City | SHELTON
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State | CT
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Zip | 06484-0264
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Country | US
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Telephone | 203-876-8854
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Fax | 203-876-2626
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY CARRUTH
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Credential | M.D.
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Telephone | 203-876-8854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 041160
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License Number State | CT
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