Provider Demographics
NPI:1396209029
Name:MY PAIN GUY LLC
Entity Type:Organization
Organization Name:MY PAIN GUY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:347-834-3008
Mailing Address - Street 1:50 QUALITY ST UNIT 110615
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-7725
Mailing Address - Country:US
Mailing Address - Phone:347-834-3008
Mailing Address - Fax:
Practice Address - Street 1:50 QUALITY ST UNIT 110615
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-7725
Practice Address - Country:US
Practice Address - Phone:347-834-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy