Provider Demographics
NPI:1366555658
Name:CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP
Entity type:Organization
Organization Name:CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LOWENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-482-5384
Mailing Address - Street 1:200 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-496-4951
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-482-5384
Practice Address - Fax:860-496-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18789332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #
CT0153620001Medicare NSC