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General NPI Number Information
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NPI Number | 1609382134
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Entity Type | Organization
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Legal Business Name | PERVIS ENTERPRISE LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 02/12/2022
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Provider Practice Location Address
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Address Line | 1 BRADLEY RD STE 505
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2292
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Country | US
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Telephone | 203-693-1164
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Fax | 203-446-5599
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 1060
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone | 203-693-1164
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Fax | 888-475-7210
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN D PERVIS
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Credential | APRN
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Telephone | 203-693-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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