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General NPI Number Information
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NPI Number | 1467516773
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Entity Type | Organization
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Legal Business Name | NORTHEAST REGIONAL RADIATION ONCOLOGY NETWORK INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4113
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Country | US
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Telephone | 860-533-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2864 JOHNSON FERRY RD SUITE 150
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City | MARIETTA
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State | GA
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Zip | 30062-8345
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Country | US
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Telephone | 770-693-2622
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Fax | 770-693-5821
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DANIEL DELGALLO
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Credential |
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Telephone | 860-646-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | CT
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