Provider Demographics
NPI:1871659540
Name:NEW ENGLAND RETINA CONSULTANTS, PC
Entity Type:Organization
Organization Name:NEW ENGLAND RETINA CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-732-2333
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-732-2333
Mailing Address - Fax:413-732-8065
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-732-2333
Practice Address - Fax:413-732-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2437107OtherAETNA USHEALTHCARE
MA1097104OtherAETNA
MA0021337OtherNEIGHBORHOOD HEALTH
MA687097OtherTUFTS
MA9737090Medicaid
MAM18963OtherBLUECROSS BLUESHIELD
MA1009673OtherNETWORK HEALTH
MA687097OtherTUFTS