Provider Demographics
NPI:1861653669
Name:ONCOLOGY HEMATOLOGY CARE OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY CARE OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHABRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-882-9608
Mailing Address - Street 1:849 BOSTON POST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3537
Mailing Address - Country:US
Mailing Address - Phone:203-882-9608
Mailing Address - Fax:203-882-9845
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3537
Practice Address - Country:US
Practice Address - Phone:203-882-9608
Practice Address - Fax:203-882-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1419052Medicaid
CT1419052Medicaid