Healthcare Provider Details

I. General information

NPI: 1922195262
Provider Name (Legal Business Name): MEDICAL ONCOLOGY & HEMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GOOSE LANE SUITE 1300
GUILFORD CT
06437
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 203-453-9192
  • Fax: 203-453-0875
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLP0L0401
License Number StateCT

VIII. Authorized Official

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