Organization
SOUTHERN NEW ENGLAND RETINA ASSOCIATES, PC
Active
Parent organization
SOUTHERN NEW ENGLAND RETINA ASSOCIATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN NEW ENGLAND RETINA ASSOCIATION
Authorized official
DR. MAGDALENA G KRZYSTOLIK M.D. (PRESIDENT)
(508) 695-9550
Entity
Organization
Contact information
Practice address
30 MANMAR DRIVE, SUITE 2, PLAINVILLE, MA 02703-2271
(508) 695-9550
(508) 695-9505
Mailing address
30 MAN MAR DR, SUITE 2, PLAINVILLE, MA 02762-2271
(508) 695-9550
(508) 695-9505
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
624129
TUFTS
MA
01
—
7246790
AETNA
MA
05
—
9004676
—
RI
05
—
9762591
—
MA
01
—
M19151
BCBS
MA
Enumeration date
05/03/2006
Last updated
07/23/2013
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