Provider Demographics
NPI:1174826598
Name:PAIN & SPINE SPECIALISTS OF CONNECTICUT, LLC
Entity Type:Organization
Organization Name:PAIN & SPINE SPECIALISTS OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-743-7246
Mailing Address - Street 1:67 SAND PIT RD SUITE 308
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4032
Mailing Address - Country:US
Mailing Address - Phone:203-743-7246
Mailing Address - Fax:203-792-3920
Practice Address - Street 1:131 KENT RD BLDG A
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3485
Practice Address - Country:US
Practice Address - Phone:860-210-8161
Practice Address - Fax:860-210-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty