Basic Information
| Provider Information | |||||||||
| NPI: | 1891727657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HAROLD LEEVER REGIONAL CANCER CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 CHASE PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035755555 | ||||||||
| FaxNumber: | 2035755562 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 CHASE PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035755555 | ||||||||
| FaxNumber: | 2035755562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | BELZEK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2035755563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | 0377 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
ID Information
| ID | Type | State | Issuer | Description | 2685544 | 01 | CT | AETNA | OTHER | 68RDONC02CT01 | 01 | CT | ANTHEM | OTHER | 4239712 | 05 | CT | MEDICAID |