Healthcare Provider Details

I. General information

NPI: 1366555658
Provider Name (Legal Business Name): CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/21/2018
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: 860-496-4951
Mailing address:
  • Phone: 860-482-5384
  • Fax: 860-496-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number18789
License Number StateCT

VIII. Authorized Official

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