Provider Demographics
NPI:1710071857
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:203-389-1666
Practice Address - Street 1:350 SEYMOUR AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1338
Practice Address - Country:US
Practice Address - Phone:203-734-1664
Practice Address - Fax:203-734-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL0459291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCL0459OtherDEPT OF PUBLIC HEALTH LIC
CT07D0095888OtherCLIA CMS