Provider Demographics
NPI:1841336849
Name:CENTRAL CONNECTICUT RADIATION ONCOLOGY PC
Entity type:Organization
Organization Name:CENTRAL CONNECTICUT RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-224-5520
Mailing Address - Street 1:760 SAYBROOK RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4785
Mailing Address - Country:US
Mailing Address - Phone:860-704-0106
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:HOSPITAL OF CENTRAL CT
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-704-0106
Practice Address - Fax:860-704-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCCRO-4074712Medicaid
C00787Medicare PIN
CTE01278Medicare UPIN
CTCCRO-4074712Medicaid
CTE01279Medicare UPIN
CTE01278Medicare UPIN
CTD85330Medicare UPIN