Healthcare Provider Details

I. General information

NPI: 1710071857
Provider Name (Legal Business Name): MEDICAL ONCOLOGY & HEMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SEYMOUR AVE SUITE 6
DERBY CT
06418-1338
US

IV. Provider business mailing address

19 LUNAR DRIVE MEDICAL ONCOLOGY AND HEMATOLOGY PC
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-734-1664
  • Fax: 203-734-1665
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCL0459
License Number StateCT

VIII. Authorized Official

Name: MS. CYNTHIA A WARANOWICZ
Title or Position: CEO
Credential:
Phone: 203-389-7504