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General NPI Number Information
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NPI Number | 1619513157
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN CARE & WELLNESS INC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 40 CROSS ST STE 301
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City | NORWALK
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State | CT
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Zip | 06851-4647
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Country | US
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Telephone | 203-956-0022
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Fax | 203-956-0024
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Provider Business Mailing Address
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Address Line | 40 CROSS ST STE 301
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City | NORWALK
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State | CT
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Zip | 06851-4647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | GENDAI ECHEZONA
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Credential | MD
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Telephone | 914-469-7877
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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