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General NPI Number Information
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NPI Number | 1740647932
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Entity Type | Organization
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Legal Business Name | ATLANTIC ANESTHESIA AND PAIN MANAGEMENT SERVICES, LLC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 4 DEARFIELD DR STE 105 DEARFIELD MEDICAL BUILDING
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City | GREENWICH
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State | CT
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Zip | 06831-5351
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Country | US
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Telephone | 203-661-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 2 COTSWOOD RD
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City | GREENWICH
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State | CT
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Zip | 06830-4713
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Country | US
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Telephone | 203-803-8828
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DMITRY MIRONOV
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Credential | MD
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Telephone | 203-803-8828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 037028
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License Number State | CT
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