Provider Demographics
NPI:1891727657
Name:THE HAROLD LEEVER REGIONAL CANCER CENTER INC
Entity Type:Organization
Organization Name:THE HAROLD LEEVER REGIONAL CANCER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BELZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-575-5563
Mailing Address - Street 1:1075 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2948
Mailing Address - Country:US
Mailing Address - Phone:203-575-5555
Mailing Address - Fax:203-575-5562
Practice Address - Street 1:1075 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2948
Practice Address - Country:US
Practice Address - Phone:203-575-5555
Practice Address - Fax:203-575-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0377261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2685544OtherAETNA
CT68RDONC02CT01OtherANTHEM
CT4239712Medicaid
CT4239712Medicaid
CT68RDONC02CT01OtherANTHEM
CT470000025Medicare ID - Type UnspecifiedMEDICARE IDTF