Provider Demographics
NPI:1922192079
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:203-589-7504
Mailing Address - Street 1:19 LUNAR DRIVE
Mailing Address - Street 2:MEDICAL ONCOLOGY & 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 1:1075 CHASE PARKWAY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-6311
Practice Address - Fax:203-755-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ONCOLOGY & HEMATOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL0599291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG7D0664949OtherCLIA
CTCL0599OtherDPH
CTG7D0664949OtherCMS
CTCL0599OtherLICENSE