Provider Demographics
NPI:1467516773
Name:NORTHEAST REGIONAL RADIATION ONCOLOGY NETWORK INC
Entity Type:Organization
Organization Name:NORTHEAST REGIONAL RADIATION ONCOLOGY NETWORK INC
Other - Org Name:COMMUNITY CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-646-1222
Mailing Address - Street 1:2864 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8345
Mailing Address - Country:US
Mailing Address - Phone:770-693-2622
Mailing Address - Fax:770-693-5821
Practice Address - Street 1:100 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4113
Practice Address - Country:US
Practice Address - Phone:860-533-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004214293Medicaid
CT33006856OtherCIGNA
CT61426856OtherSAGA
CT2139370OtherAETNA MEDICARE
CTA1725354OtherOXFORD
CT2158621OtherAETNA USHC
CT954221OtherCONNECTICARE
CT68RDONC01CT1OtherANTHEM BS
CT61426856OtherSAGA