=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124776299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRONIC PAIN AND REGENERATIVE MEDICINE ASSOCIATES, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2022
-----------------------------------------------------
Last Update Date | 06/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 FEDERAL RD STE 107
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06811-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-470-9156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 FEDERAL RD STE 107
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06811-4047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-470-9156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LOUIS SCLAFANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-470-9165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------