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General NPI Number Information
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NPI Number | 1881936029
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT ASSOCIATES OF GLASTONBURY LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 394 W CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4735
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Country | US
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Telephone | 860-759-0060
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Fax | 860-633-6041
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Provider Business Mailing Address
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Address Line | 318 FELDSPAR RDG
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City | GLASTONBURY
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State | CT
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Zip | 06033-3391
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Country | US
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Telephone | 860-759-0060
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Fax | 860-633-6041
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | EWA GASZEK
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Credential |
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Telephone | 860-282-4137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CT
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | CT
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