Provider Demographics
NPI:1013456896
Name:CT INTEGRATED PAIN CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CT INTEGRATED PAIN CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHAODI
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-815-9916
Mailing Address - Street 1:30 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2510
Mailing Address - Country:US
Mailing Address - Phone:203-815-9916
Mailing Address - Fax:203-557-6688
Practice Address - Street 1:125 KINGS HWY N
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2428
Practice Address - Country:US
Practice Address - Phone:203-815-9916
Practice Address - Fax:203-557-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52543207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty