Healthcare Provider Details

I. General information

NPI: 1619140829
Provider Name (Legal Business Name): CONNECTICUT ONCOLOGY & HEMATOLOGY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KENNEDY DR
TORRINGTON CT
06790-3096
US

IV. Provider business mailing address

200 KENNEDY DR
TORRINGTON CT
06790-3096
US

V. Phone/Fax

Practice location:
  • Phone: 860-482-5384
  • Fax: 860-496-5072
Mailing address:
  • Phone: 860-482-5384
  • Fax: 860-496-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number07D0100617
License Number StateCT

VIII. Authorized Official

Name: DR. IVAN S LOWENTHAL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 860-482-5384