Provider Demographics
NPI:1619513157
Name:PREMIER PAIN CARE & WELLNESS INC
Entity Type:Organization
Organization Name:PREMIER PAIN CARE & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GENDAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEZONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-469-7877
Mailing Address - Street 1:40 CROSS ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 CROSS ST STE 301
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4647
Practice Address - Country:US
Practice Address - Phone:203-956-0022
Practice Address - Fax:203-956-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty