Provider Demographics
NPI:1467986638
Name:PAIN MANAGEMENT ASSOCIATES OF CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES OF CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-325-5700
Mailing Address - Street 1:38B GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4665
Mailing Address - Country:US
Mailing Address - Phone:203-325-5700
Mailing Address - Fax:203-325-8080
Practice Address - Street 1:38B GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4665
Practice Address - Country:US
Practice Address - Phone:203-325-5700
Practice Address - Fax:203-325-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT32179207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02854Medicare UPIN
CTG14148Medicare UPIN