Provider Demographics
NPI:1205042793
Name:EASTERN REHABILITATION NETWORK HEADACHE CLINIC
Entity Type:Organization
Organization Name:EASTERN REHABILITATION NETWORK HEADACHE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-667-5480
Mailing Address - Street 1:181 PATRICIA GENOVA DRIVE
Mailing Address - Street 2:EASTERN REHABILITATION NETWORK (5TH FLOOR)
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-667-5480
Mailing Address - Fax:860-667-8416
Practice Address - Street 1:144 MAIN STREET
Practice Address - Street 2:HEADACHE CLINIC
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-657-4723
Practice Address - Fax:860-652-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076536Medicare ID - Type Unspecified