Provider Demographics
NPI:1417556317
Name:NEW ENGLAND ADVANCED SPINE & PAIN CENTER LLC
Entity Type:Organization
Organization Name:NEW ENGLAND ADVANCED SPINE & PAIN CENTER LLC
Other - Org Name:NEW ENGLAND ADVANCED SPINE & PAIN CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:O
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-548-7590
Mailing Address - Street 1:137 HOLLOW TREE RIDGE RD APT 223
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4056
Mailing Address - Country:US
Mailing Address - Phone:631-624-6610
Mailing Address - Fax:
Practice Address - Street 1:47 OAK ST STE 110
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5320
Practice Address - Country:US
Practice Address - Phone:203-548-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty