Healthcare Provider Details

I. General information

NPI: 1073549648
Provider Name (Legal Business Name): MEDICAL ONCOLOGY & HEMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA COPPOLA
Title or Position: BUSINESS MANAGER
Credential: MHA
Phone: 203-389-7504