Basic Information
| Provider Information | |||||||||
| NPI: | 1962806679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW SOLUTIONS PAIN MANAGEMENT CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 256 SEASIDE AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064604602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4758826824 | ||||||||
| FaxNumber: | 2036932320 | ||||||||
| Practice Location | |||||||||
| Address1: | 256 SEASIDE AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064604602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4758826824 | ||||||||
| FaxNumber: | 2036932320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2014 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | TESTO | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | APRN | ||||||||
| AuthorizedOfficialTelephone: | 4758826824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 004689 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.