Provider Demographics
NPI:1114011269
Name:MEDICAL ONCOLOGY & HEMATOLOGY PC
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY & HEMATOLOGY PC
Other - Org Name:DIAGNOSTIC HEMATOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-389-7504
Mailing Address - Street 1:19 LUNAR DRIVE
Mailing Address - Street 2:MEDICAL ONCOLOGY AND HEMATOLOGY PC
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-389-7504
Mailing Address - Fax:203-389-8854
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451
Practice Address - Country:US
Practice Address - Phone:203-238-7747
Practice Address - Fax:203-686-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL0326291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCL0326OtherDEPT PUBLIC HEALTH LICENS