Provider Demographics
NPI:1851771273
Name:MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC
Entity Type:Organization
Organization Name:MUSCULOSKELETAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, PC
Other - Org Name:MULTICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, PA-C
Authorized Official - Phone:860-570-3400
Mailing Address - Street 1:1224 MILL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:860-570-3400
Mailing Address - Fax:860-570-0750
Practice Address - Street 1:1224 MILL ST STE 201
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-570-3400
Practice Address - Fax:860-570-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1799111N00000X
CT25728204D00000X
CT3244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty