Provider Demographics
NPI:1497876502
Name:NEW ENGLAND RETINA ASSOCIATES, P.C
Entity Type:Organization
Organization Name:NEW ENGLAND RETINA ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONNERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-288-2020
Mailing Address - Street 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:203-288-2020
Mailing Address - Fax:203-288-2470
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-288-2020
Practice Address - Fax:203-288-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004182789Medicaid
CT004182789Medicaid