Provider Demographics
NPI:1316275241
Name:COMPREHENSIVE NEUROLOGY AND PAIN CENTER OF CONNECTICUT, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE NEUROLOGY AND PAIN CENTER OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TUROK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-626-9080
Mailing Address - Street 1:67 MASONIC AVE
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3095
Mailing Address - Country:US
Mailing Address - Phone:203-626-9080
Mailing Address - Fax:203-626-9074
Practice Address - Street 1:67 MASONIC AVE
Practice Address - Street 2:SUITE 2400
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3095
Practice Address - Country:US
Practice Address - Phone:203-626-9080
Practice Address - Fax:203-626-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045712208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100012841Medicare PIN