Healthcare Provider Details

I. General information

NPI: 1790026854
Provider Name (Legal Business Name): DUDLEY STREET OPERATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRIDGE ST
PROVIDENCE RI
02903-4362
US

IV. Provider business mailing address

2 DUDLEY ST SUITE 465
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-855-5633
  • Fax:
Mailing address:
  • Phone: 401-855-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPHS00005
License Number StateRI

VIII. Authorized Official

Name: DR. RICHARD ZIENOWICZ
Title or Position: PARTNER
Credential: M.D.
Phone: 401-855-5633