Provider Demographics
NPI:1871542993
Name:PAIN MANAGEMENT ASSOCIATES OF CONNECTICUT, P.C.
Entity type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES OF CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-325-5700
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-325-5700
Mailing Address - Fax:203-325-8080
Practice Address - Street 1:999 SUMMER STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5513
Practice Address - Country:US
Practice Address - Phone:203-325-5700
Practice Address - Fax:203-325-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG14148Medicare UPIN
CTC02854Medicare UPIN