Provider Demographics
NPI:1356432710
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:MEMBER, OWNER PHYSICIAN
Authorized Official - Prefix:DR
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 1:40 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3535
Mailing Address - Country:US
Mailing Address - Phone:203-882-9608
Mailing Address - Fax:203-882-9845
Practice Address - Street 1:40 COMMERCE PARK
Practice Address - Street 2:ONCOLOGY HEMATOLOGY CARE OF CONNECTICUT LLC
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-0000
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:2006-09-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042964207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001429647Medicaid
CT110009407Medicare PIN