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Organization

SOUTHERN NEW ENGLAND RETINA ASSOCIATES, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MAGDALENA G KRZYSTOLIK M.D. (PRESIDENT)
(401) 453-4600
Entity
Organization

Contact information

Practice address
1 RANDALL SQ, SUITE 203, PROVIDENCE, RI 02904-2709
(401) 453-4600
(401) 453-0077
Mailing address
1 RANDALL SQ, SUITE 203, PROVIDENCE, RI 02904-2709
(401) 453-4600
(401) 453-0077

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
624129
TUFTS HEALTH CARE
RI
01
7246790
AETNA
RI
05
9004676
RI
05
9762591
MA
01
M19151
BCBS
MA
Enumeration date
05/03/2006
Last updated
07/20/2011
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