Provider Demographics
NPI:1275704413
Name:ADVANCED SPINE AND PAIN CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YUTING
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:203-324-2128
Mailing Address - Street 1:970 SUMMER STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5518
Mailing Address - Country:US
Mailing Address - Phone:203-324-2128
Mailing Address - Fax:203-588-1705
Practice Address - Street 1:970 SUMMER STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5518
Practice Address - Country:US
Practice Address - Phone:203-324-2128
Practice Address - Fax:203-588-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040627208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH36135Medicare UPIN