Provider Demographics
NPI:1972556165
Name:HARTFORD HEADACHE CENTER, LLC
Entity type:Organization
Organization Name:HARTFORD HEADACHE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HARTFORD HEADACHE CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BILCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-895-3133
Mailing Address - Street 1:144 MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118
Mailing Address - Country:US
Mailing Address - Phone:860-895-3133
Mailing Address - Fax:860-895-3131
Practice Address - Street 1:144 MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118
Practice Address - Country:US
Practice Address - Phone:860-895-3133
Practice Address - Fax:860-895-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03156OtherMEDICARE PTAN