Provider Demographics
NPI:1710941406
Name:PAIN MANAGEMENT CENTER OF NEW ENGLAND
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:K
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-248-1134
Mailing Address - Street 1:2440 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3222
Mailing Address - Country:US
Mailing Address - Phone:203-248-1134
Mailing Address - Fax:203-288-6132
Practice Address - Street 1:2440 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3222
Practice Address - Country:US
Practice Address - Phone:203-248-1134
Practice Address - Fax:203-288-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497217OtherCIGNA
CT010026896CT02OtherANTHEM BCBS
CTOV6331OtherHEALTHNET
CTOV6331OtherHEALTHNET