Provider Demographics
NPI:1790598787
Name:CONNECTICUT PROTON THERAPY CENTER, LLC
Entity type:Organization
Organization Name:CONNECTICUT PROTON THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-649-4060
Mailing Address - Street 1:23472 N SANCTUARY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8626
Mailing Address - Country:US
Mailing Address - Phone:630-649-4060
Mailing Address - Fax:312-896-9537
Practice Address - Street 1:932 NORTHOP ROAD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:630-649-4060
Practice Address - Fax:312-896-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation