Provider Demographics
NPI:1053695098
Name:PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-661-9383
Mailing Address - Street 1:2015 WEST MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4536
Mailing Address - Country:US
Mailing Address - Phone:203-863-4588
Mailing Address - Fax:203-661-6724
Practice Address - Street 1:2015 WEST MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4536
Practice Address - Country:US
Practice Address - Phone:203-863-4588
Practice Address - Fax:203-661-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty