Provider Demographics
NPI:1053713800
Name:CONNECTICUT HEADACHE AND MIGRAINE RELIEF CENTER LLC
Entity type:Organization
Organization Name:CONNECTICUT HEADACHE AND MIGRAINE RELIEF CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-531-5688
Mailing Address - Street 1:235 GLENVILLE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-4148
Mailing Address - Country:US
Mailing Address - Phone:203-531-5688
Mailing Address - Fax:203-531-5663
Practice Address - Street 1:235 GLENVILLE RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-4148
Practice Address - Country:US
Practice Address - Phone:203-531-5688
Practice Address - Fax:203-531-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty