Basic Information
| Provider Information | |||||||||
| NPI: | 1306975347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURMONAVICIUS | ||||||||
| FirstName: | JOANNA | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR STE 212 | ||||||||
| Address2: | ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036244208 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LONG WHARF DR STE 212 | ||||||||
| Address2: | ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036244208 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 001749 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.