# PETER T. KRENICKY MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982914354
- **Authorized official:** DR. PETER T KRENICKY M.D. (PRINCIPLE)
- **Authorized official phone:** (860) 528-9645

## Contact information

- **Practice address:** 477 CONNECTICUT BLVD., SUITE 205, EAST HARTFORD, CT 06108
- **Practice address phone:** (860) 528-9645
- **Practice address fax:** (860) 528-6366
- **Mailing address:** 477 CONNECTICUT BLVD., SUITE 205, EAST HARTFORD, CT 06108
- **Mailing address phone:** (860) 528-9645
- **Mailing address fax:** (860) 528-6366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 013523 | CT | Yes |

## Other

- **Enumeration date:** 10/19/2010
- **Last updated:** 10/19/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001135235 | — | CT |
| 01 | — | 010013529CT | BCBS OF CT | CT |
| 01 | — | 013523 | CONNETICARE | CT |
| 01 | — | 117584 | EYEMED | CT |
| 01 | — | 298521 | WELLCARE | CT |