Provider Demographics
NPI:1083904163
Name:ADVANCED PAIN SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-544-9090
Mailing Address - Street 1:112 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-3119
Mailing Address - Country:US
Mailing Address - Phone:203-544-9090
Mailing Address - Fax:203-544-7300
Practice Address - Street 1:112 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-3119
Practice Address - Country:US
Practice Address - Phone:203-544-9090
Practice Address - Fax:203-544-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042785207Q00000X
CT0415162081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty