Provider Demographics
NPI:1881724912
Name:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTERS PC
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SABERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-624-4208
Mailing Address - Street 1:1 LONG WHARF DR STE 212
Mailing Address - Street 2:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5593
Mailing Address - Country:US
Mailing Address - Phone:203-624-4208
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DR STE 212
Practice Address - Street 2:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5593
Practice Address - Country:US
Practice Address - Phone:203-624-4208
Practice Address - Fax:203-624-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTIN
CTC02502Medicare UPIN