Provider Demographics
NPI:1851932016
Name:ADVANCED WELLNESS AND MUSCULOSKELETAL PAIN CLINIC PLLC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS AND MUSCULOSKELETAL PAIN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TSOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-603-2993
Mailing Address - Street 1:595 SUMMER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1407
Mailing Address - Country:US
Mailing Address - Phone:203-998-7688
Mailing Address - Fax:475-333-0511
Practice Address - Street 1:595 SUMMER ST STE 1
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1407
Practice Address - Country:US
Practice Address - Phone:203-998-7688
Practice Address - Fax:475-333-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty