Healthcare Provider Details

I. General information

NPI: 1497876502
Provider Name (Legal Business Name): NEW ENGLAND RETINA ASSOCIATES, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 300
HAMDEN CT
06518
US

IV. Provider business mailing address

2200 WHITNEY AVE SUITE 300
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2020
  • Fax: 203-288-2470
Mailing address:
  • Phone: 203-288-2020
  • Fax: 203-288-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA A. CONNERTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 203-288-2020