Provider Demographics
NPI:1609382134
Name:PERVIS ENTERPRISE LLC
Entity Type:Organization
Organization Name:PERVIS ENTERPRISE LLC
Other - Org Name:INTEGRATIVE PAIN AND PSYCH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-693-1164
Mailing Address - Street 1:304 S JONES BLVD # 1060
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:203-693-1164
Mailing Address - Fax:888-475-7210
Practice Address - Street 1:1 BRADLEY RD STE 505
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2292
Practice Address - Country:US
Practice Address - Phone:203-693-1164
Practice Address - Fax:203-446-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty