OrganizationActive
Providence Interventional Associates II LLC
NPI 1306123476 · Vascular & Interventional Radiology Physician · Providence, RI
Provider details
- NPI number
- 1306123476
- Entity type
- Organization
- Primary specialty
- Vascular & Interventional Radiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jonah Licht, Owner(401) 277-9729
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Nephrology Physician207RN0300X
Allopathic & Osteopathic Physicians
Practice location
100 Highland Ave Ste 100
Providence, RI 02906-2740
Phone: (401) 277-9729
Fax: (401) 277-9730
Approximate (ZIP-level) locationGet directions
Mailing address
100 Highland Ave Ste 100
Providence, RI 02906-2740
Registry dates
- Enumerated
- 2011-11-03
- Last updated
- 2025-06-13
- Certified
- 2025-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.