Basic Information
| Provider Information | |||||||||
| NPI: | 1881724912 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED DIAGNOSTIC PAIN TREATMENT CENTERS PC | ||||||||
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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: | 03/07/2007 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | SABERSKI | ||||||||
| AuthorizedOfficialFirstName: | LLOYD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2036244208 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.