Provider Demographics
NPI:1306975347
Name:FURMONAVICIUS, JOANNA (PAC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:FURMONAVICIUS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR STE 212
Mailing Address - Street 2:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5593
Mailing Address - Country:US
Mailing Address - Phone:203-624-4208
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DR STE 212
Practice Address - Street 2:ADVANCED DIAGNOSTIC PAIN TREATMENT CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5593
Practice Address - Country:US
Practice Address - Phone:203-624-4208
Practice Address - Fax:203-624-4301
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001749363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002605Medicare PIN
CTQ66892Medicare UPIN
970002125Medicare ID - Type Unspecified