Provider Demographics
NPI:1396382685
Name:OPTIMUM REGENERATIVE CARE LLC
Entity Type:Organization
Organization Name:OPTIMUM REGENERATIVE CARE LLC
Other - Org Name:CONNECTICUT CENTERS FOR NEUROPATHY & CHRONIC PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEOFFRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-917-4774
Mailing Address - Street 1:46 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 STONY HILL RD STE 208
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1045
Practice Address - Country:US
Practice Address - Phone:203-917-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty