Healthcare Provider Details

I. General information

NPI: 1992737449
Provider Name (Legal Business Name): CONNECTICUT ONCOLOGY&HEMATOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
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 TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number003622
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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