Provider Demographics
NPI:1497194419
Name:TRIGGERBAND PAIN CLINIC OF NEW ENGLAND LLC
Entity Type:Organization
Organization Name:TRIGGERBAND PAIN CLINIC OF NEW ENGLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TYPALDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-703-0813
Mailing Address - Street 1:881 LAFAYETTE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1242
Mailing Address - Country:US
Mailing Address - Phone:603-601-7364
Mailing Address - Fax:
Practice Address - Street 1:881 LAFAYETTE RD
Practice Address - Street 2:SUITE D
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1242
Practice Address - Country:US
Practice Address - Phone:603-601-7364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIGGERBAND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-24
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty