Provider Demographics
NPI:1922195262
Name:MEDICAL ONCOLOGY & HEMATOLOGY
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY & HEMATOLOGY
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:203-389-8834
Practice Address - Street 1:111 GOOSE LANE
Practice Address - Street 2:SUITE 1300
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437
Practice Address - Country:US
Practice Address - Phone:203-453-9192
Practice Address - Fax:203-453-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCLP0L0401291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CLP0L0401OtherPUBLIC HEALTH DEPT LICENS