Basic Information
| Provider Information | |||||||||
| NPI: | 1710071857 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ONCOLOGY & HEMATOLOGY PC | ||||||||
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| OtherOrganizationName: | DIAGNOSTIC HEMATOLOGY LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 LUNAR DRIVE | ||||||||
| Address2: | MEDICAL ONCOLOGY AND HEMATOLOGY PC | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033897504 | ||||||||
| FaxNumber: | 2033891666 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 SEYMOUR AVE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | DERBY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064181338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037341664 | ||||||||
| FaxNumber: | 2037341665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | WARANOWICZ | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2033897504 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | CL0459 | CT | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | CL0459 | 01 | CT | DEPT OF PUBLIC HEALTH LIC | OTHER | 07D0095888 | 01 | CT | CLIA CMS | OTHER |